Assessment Form

I am a:

Parent / Guardian

Student Information

First name:

Jana

Last name:

Shirazinejad

age:

3 years and 3 months

Discipline:

Full time daycare

Parent/Guardian Information

First Name:

Salma

Last Name:

Seyedahmadi

Enter Email:

salmass1@yahoo.ca

Contact Number:

4039099663

Note:

Hello I am sending this message to ask you for booking an assessment time for my Daughter, Jana. I am really interested to register her in your Orff music class. Regards Salma