Register #9175 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Eileen

Last name:

Zhou

Date of Birth:

2018-02-16

Parent Information

First name:

Joe

Last name:

Zhou

Parent / Guardian's Email:

chekazhou@gmail.com

Contact Number:

6043690765

Relationship to student:

Father

Address

Country:

Canada

City:

Port Coquitlam

State / Province / Region:

BC

Address Line 1:

3169 Jervis St

Address Line 2:

ZIP / Postal Code:

V3C 3H6

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:

Violin

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

Once a week

Which days are you available for lessons?

Saturdays, Sunday

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

Referral

Referrer:

Belinda Xin