Los Angeles School of Music
2019 Student Registration Form
Student Name *
Your answer
Age *
Your answer
Birthday *
Your answer
Parent's Name (if under 18)
Your answer
Address (Street, City, State, Zip Code) *
Your answer
Phone Number *
Your answer
Email *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Allergy Information
Your answer
How did you hear about us? *
Required
Photo and Video Release *
Does the instructor have permission to feature photos and/or videos of this student on the studio website or Facebook page?
Required
What would you like to learn from lessons? *
Your answer
Anything else you would like the teacher to know?
Your answer
I agree to abide by the terms of the LASoM Studio Policy. *
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