Application for enrolment for one-to-one lessons

Student's personal details

Given / first name

Family / surname / last name

Date of birth

Student's gender

What is the main language spoken at home?

Are you of Aboriginal and/or Torres Strait Islander origin?

Parent or caregiver's details

Parent or caregiver's full name

Parent or caregiver's mobile/phone number

Postal address

Parent or caregiver's email address

Emergency contact

Emergency contact name, if different from the parent or caregiver's

Emergency contact number, if different from the parent or caregiver's

Relationship to student

Student's academic background

Student's current school

Student's year level at school

If the student has completed any AMEB examinations or similar, please specify the highest level attained

Media release

Media release agreement

I grant permission to the University of Adelaide to use, reproduce and communicate (in hardcopy or electronic format) any photographs, audio and/or video recordings taken of this student during Open Music Academy activities for the purposes of:

University publications and promotional activities (including but not limited to the University’s website and social media sites, promotional and marketing materials and student recruitment activities);
The University’s administrative and teaching purposes I acknowledge and agree that this may result in public disclosure of this student’s image.

Agreement

I/We agree to the payment of the fees associated with the above mentioned program.

OMA Conditions of Enrolment

I am over the age of 18 or I have sought permission from a parent/guardian