Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Tabassom

Last name:

Asgharizola

Date of Birth:

2007-06-04

Parent Information

First name:

Nasrin

Last name:

Eyvariboroushghalan

Parent / Guardian's Email:

sh.gh.tr2022@gmail.com

Contact Number:

2365159855

Relationship to student:

Daughter

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

1001 2968 Glen Dr

Address Line 2:

Grand central 2

ZIP / Postal Code:

V3B 0C4

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?

Monday

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

Social Media (Instagram, Facebook)

Referrer: