Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Baran

Last name:

Ramezi

Date of Birth:

2014-07-27

Parent Information

First name:

Sanaz

Last name:

Mehrabani

Parent / Guardian's Email:

baranramezi@yahoo.com

Contact Number:

+1 7788598785

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

1292 Michigan Dr

Address Line 2:

ZIP / Postal Code:

V3b6t8

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?

Tuesday

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

Word of Mouth

Referrer: