BIRDIE BASICS REGISTRATION FORM
Student Guardian Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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How Many Students Are You Enrolling?
*
Please Select
1
2
3
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Student Information
Name
*
First Name
Last Name
Age
*
Name
*
First Name
Last Name
Age
*
Name
*
First Name
Last Name
Age
*
What is the student's experience level?
*
Beginner
Intermediate
Advanced
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Add Another Email to the Program Email List
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
Name
First Name
Last Name
Email
example@example.com
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Liability and Release
*
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Any Other Comments or Questions?
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Submit
Submit
Should be Empty: