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Name *

Address *

Date of Birth (MM/DD/YYYY) *

Phone Number (###) ###-#### *

Email Address

Gener *

Current School *

Current Grade *

Current expulsion/suspension record *

Parent/Guardian name *

THE PERFORMING ARTS CONSERVATORY IS A 501(c)3 ORGANIZATION. ALL RIGHTS RESERVED.

The Performing Arts Conservatory is an equal opportunity employer. Students and Facilitators of all races and ethnic origins are accepted.