Register #9471 - vancomusic

Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Logan

Last name:

Watts

Date of Birth:

2013-10-26

Parent Information

First name:

Jesse

Last name:

Watts

Parent / Guardian's Email:

jessewatts99@gmail.com

Contact Number:

6049991884

Relationship to student:

Father

Address

Country:

CANADA

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

1702-1155 The High Street

Address Line 2:

ZIP / Postal Code:

V3B7W4

Program Selection

I am looking for:

In-person Lessons

What level would you like to register?

Level 5-8

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?

Sunday

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

Search Engine (Google, Bing, etc.)

Referrer:

Website