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Print Out The OMA Enrollment Form
ONALASKA MUSIC ACADEMY
1052 Oak Forest Drive, Suite 380
Onalaska, WI 54650
608.779.5377
www.onalaskamusicacademy.com
ENROLLMENT/CONSENT FORM
How did you hear about Onalaska Music Academy?____________________________________________________________________________________________
Name: _______________________________________ Date: ________________
Parent/Guardian Name: _______________________________________________
Address: ___________________________________________________________
City: __________________________________ State: ________ Zip:__________
Home Phone: ________________ Cell: _______________ Work: _____________
Email: _____________________________________________________________
Instructor’s Name: __________________________ Lesson Time: _____________
Student’s Birthdate: __________________________ Male/Female: ____________
EMERGENCY CONTACT INFORMATION
1. Name: __________________ Relationship: ________ Phone: ______________
By signing below, you agree to the policies of Onalaska Music Academy,
LLC Signature: _______________________________________ Date: _____________
Photo Waiver
At the studio we occasionally take pictures of faculty, families and students for use on the website or other print media. Full names are withheld.
I, ________________, give permission to have pictures of _________________ to
be used by Onalaska Music Academy, LLC.
Parent/Guardian Signature: ____________________________________________
Onalaska Music Academy, LLC.
608-779-LESSONS (5377)
