apply for lessons

Applicant Name *

This may be your child's name

First Name

Last Name

Phone

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

Female

Male

Prefer not to say

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Primary phone number *

(###)

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Referee Name *

The referee must agree to be a reference prior to submission of this application. They will be contacted by CMSWR staff.

First Name

Last Name

Referee's Phone Number *

(###)

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