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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)



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