Register - Online / Langley BC - School of Music & Dance

Register for a Class

$79.00/mth

Tuesday 5:00pm for 30 min. with Miss Alicia

Student You Are Registering You can register other students under the same account later.
First Name:	usually their given name
Last Name:	usually their family name
Gender:	Female Male
Birth Date:	,
Medical conditions / allergies:
Contact Person (You)	Copy student name
First Name:	usually your given name
Last Name:	usually your family name
Relation to Student:

Mobile Phone:	() -
Home Phone:	() -
Work Phone:	() - ext.

Email address:
Choose a Password:	8+ digits
Repeat Password:
Family Info
Address: (of the student)
City:
Province:
Postal Code:

How did you hear about us?	Referral from: Bring A Friend Day Online Search Preschool Field Trip Signage Postcard Chatterblock Other, specify: