Academy of Music, Art & Education LLC

                                                                                            

Please return form to:

Academy of Music, Art & Education LLC

950 Corporate Parkway, Suite 100

Wentzville, MO 63385                                                                Todays Date:______________

Email: jacque@academymae.com                                              

Name:____________________________________________Birth Date:________________

Address:__________________________________________Phone:___________________

_________________________________________________ Zip:_____________________

Parents name(s)_____________________________________________________________

Email:_______________________________School:________________________________

Requested Class:____________________________________________________________

Educational need:___________________________________________________________

Date & time requested  - 1st choice _____________________________________________

Date & time requested - 2nd choice _____________________________________________

Date & time requested - 3rd choice _____________________________________________

How did you hear about us? ___________________________________________________

Applications will be reviewed and interviews setup to match you with the best teacher for your child/self.

A $29.00 registration fee will be due upon registration.

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