Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Sarina Sadat

Last name:

Sakhi Javarashk

Date of Birth:

2014-08-06

Parent Information

First name:

Seyed Mostafa

Last name:

Sakhi Javarashk

Parent / Guardian's Email:

ms.manager6681@gmail.com

Contact Number:

7789706681

Relationship to student:

Father

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

B.C

Address Line 1:

3080 Lincoln Ave

Address Line 2:

ZIP / Postal Code:

V3B0L9

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?

Saturdays

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

Referral

Referrer:

Afarin