Register #8784 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Evan

Last name:

Chang

Date of Birth:

2017-11-10

Parent Information

First name:

Clara

Last name:

Suh

Parent / Guardian's Email:

jinjusuh@gmail.com

Contact Number:

2368805673

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

3102 windsorgate

Address Line 2:

ZIP / Postal Code:

V3B0J3

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:

Piano

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

Thrice a week

Which days are you available for lessons?

Monday, Tuesday, Wednesdays, Fridays

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

Search Engine (Google, Bing, etc.)

Referrer: