Sarah McLachlan School of Music Online Registration

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Welcome to SoM! We exist to provide free music education, long term supportive mentorship and safe place to explore your creativity for youth in Vancouver, Edmonton and selected schools in Surrey who face socio-economic barriers to access. Please visit our website for more information on which schools are eligible. We look forward to receiving your application! Please note that we are not currently accepting applications for new students for our Surrey program.

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Home or Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

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Contact #1

Contact #1 First Name*

Last Name *

Type*

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Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

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Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

Work #

Cell #

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Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email*

School*

Grade Level*

Are you applying because of a Partner Program, Financial need, or Social-Emotional need?*

Please outline any learning or behavioural supports that the student may need in our programs?

Allergies/Dietary Restrictions*

Does the student have any medical conditions we should be aware of?

What languages are spoken at home?*

For the student to answer: What do you like about music? Is there anything you would love to learn?*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email*

School*

Grade Level*

Are you applying because of a Partner Program, Financial need, or Social-Emotional need?*

Please outline any learning or behavioural supports that the student may need in our programs?

Allergies/Dietary Restrictions*

Does the student have any medical conditions we should be aware of?

What languages are spoken at home?*

For the student to answer: What do you like about music? Is there anything you would love to learn?*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email*

School*

Grade Level*

Are you applying because of a Partner Program, Financial need, or Social-Emotional need?*

Please outline any learning or behavioural supports that the student may need in our programs?

Allergies/Dietary Restrictions*

Does the student have any medical conditions we should be aware of?

What languages are spoken at home?*

For the student to answer: What do you like about music? Is there anything you would love to learn?*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email*

School*

Grade Level*

Are you applying because of a Partner Program, Financial need, or Social-Emotional need?*

Please outline any learning or behavioural supports that the student may need in our programs?

Allergies/Dietary Restrictions*

Does the student have any medical conditions we should be aware of?

What languages are spoken at home?*

For the student to answer: What do you like about music? Is there anything you would love to learn?*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email*

School*

Grade Level*

Are you applying because of a Partner Program, Financial need, or Social-Emotional need?*

Please outline any learning or behavioural supports that the student may need in our programs?

Allergies/Dietary Restrictions*

Does the student have any medical conditions we should be aware of?

What languages are spoken at home?*

For the student to answer: What do you like about music? Is there anything you would love to learn?*

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Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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