Registration Form

I am a:

Parent / Guardian

Student Information

First name:

Nicolas

Last name:

Luna

Date of Birth:

2007-12-20

Parent Information

First name:

Alexis

Last name:

Luna

Parent / Guardian's Email:

alexisluna.c@gmail.com

Contact Number:

2366885009

Relationship to student:

Father

Address

Country:

Canada

City:

Coquitlam

State / Province / Region:

BC

Address Line 1:

595 Austin Ave.

Address Line 2:

ZIP / Postal Code:

V3K0G7

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:

Search Engine (Google, Bing, etc.)

Referrer:

None