Register #8812 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Alina

Last name:

Fenrick

Date of Birth:

2008-03-05

Parent Information

First name:

Gina

Last name:

Fenrick

Parent / Guardian's Email:

gbjarn@gmail.com

Contact Number:

7788994462

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

1814 Harbour Dr

Address Line 2:

ZIP / Postal Code:

V3J 5W7

Program Selection

I am looking for:

In-person Lessons

What level would you like to register?

Preliminary

Please write the program or instrument you are interested in:

Piano

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

Once a week

Which days are you available for lessons?

Monday, Wednesdays, Saturdays

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

Search Engine (Google, Bing, etc.)

Referrer: