Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Elena

Last name:

Rostama

Date of Birth:

2021-08-19

Parent Information

First name:

Forouz

Last name:

Ghaffari

Parent / Guardian's Email:

ghaffarizadeh.forouz@gmail.com

Contact Number:

7788477548

Relationship to student:

Mother

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

British Columbia

Address Line 1:

1546 Salal Cres

Address Line 2:

ZIP / Postal Code:

v3e 2v6

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, Singing

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

Once a week

Which days are you available for lessons?

Monday, Tuesday, Wednesdays, Thursdays, Fridays, Saturdays, Sunday

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

Search Engine (Google, Bing, etc.)

Referrer: