Register #8769 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Hari

Last name:

Kim

Date of Birth:

2016-09-10

Parent Information

First name:

Eunha

Last name:

Jo

Parent / Guardian's Email:

pianoeunha@gmail.com

Contact Number:

7788594701

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

134-1310 mitchell st

Address Line 2:

ZIP / Postal Code:

V3E0T9

Program Selection

I am looking for:

In-person Lessons

What level would you like to register?

Level 1-4

Please write the program or instrument you are interested in:

violin

How many days a week would you like to have classes?

Once a week

Which days are you available for lessons?

Monday, Tuesday, Wednesdays, Thursdays

We'd love to know how you heard about us:

Search Engine (Google, Bing, etc.)

Referrer: