Music Therapy Fall 2025 Interest Survey

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* 8. Caregiver Contract - A breach in this agreement could result in a forfeit of your class without a refund.

By clicking each box, you consent the following statements:

I understand that this is a parent/child attended class. I will stay in the music room with my child for the entire class, unless otherwise directed by the music therapist.

I will treat the music therapist, support staff, and other families with respect and dignity.

I understand that the $90 registration fee payment is required before the start of the first class. If I chose to pay this fee on the day of the first class, I will need to arrive early to pay or I may miss the beginning of class. If the fee is a barrier, I will reach out the LIFE Program.

I understand that the registration paperwork is required before the start of the first class. Paperwork can be dropped off, faxed, or mail to LIFE Program. If I chose to complete the forms on the day of the first class, I will need to arrive early to do so or I may miss the beginning of class.

I understand that my child and I may need to remove our shoes before entering the music room to ensure that the space stays clean for everyone.

I understand that the space available during music therapy includes the couches in the lobby and the music room. I do not have access to other spaces as there are other groups that have booked these spaces for the day. I understand that the atrium is closed and is not able to be accessed during music therapy.

I understand as per the attendance policy that I need to notify the music therapist at the beginning of the session of any known absences and I will notify weekly of unexpected absences. Should my child miss two sessions in a row without notice, we may forfeit our spot in the class.

Music Therapy Fall 2025 Interest Survey

LIFE Program Music Therapy Fall 2025

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* 1. Parent's Full Name

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* 2. Parent email address

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* 3. Age of child as of October 25, 2025

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* 4. Please select the option that applies:

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* 5. First choice for Music Therapy Class:

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* 6. Second choice for Music Therapy Class:

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* 7. Third choice for Music Therapy Class:

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* 8. Caregiver Contract - A breach in this agreement could result in a forfeit of your class without a refund.

By clicking each box, you consent the following statements:

Music Therapy Fall 2025 Interest Survey

LIFE Program Music Therapy Fall 2025

Question Title

* 1. Parent's Full Name

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* 2. Parent email address

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* 3. Age of child as of October 25, 2025

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* 4. Please select the option that applies:

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* 5. First choice for Music Therapy Class:

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* 6. Second choice for Music Therapy Class:

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* 7. Third choice for Music Therapy Class:

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* 8. Caregiver Contract - A breach in this agreement could result in a forfeit of your class without a refund.By clicking each box, you consent the following statements:

* 8. Caregiver Contract - A breach in this agreement could result in a forfeit of your class without a refund.

By clicking each box, you consent the following statements: