Register #9463 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Eileen

Last name:

Zhou

Date of Birth:

2018-02-25

Parent Information

First name:

Jiawei

Last name:

Sun

Parent / Guardian's Email:

chekazhou@gmail.com

Contact Number:

6043690765

Relationship to student:

Mother

Address

Country:

Canada

City:

Port Coquitlam

State / Province / Region:

Bc

Address Line 1:

3169 Jervis st

Address Line 2:

ZIP / Postal Code:

V3c3h6

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?

Sunday

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

Search Engine (Google, Bing, etc.)

Referrer: