A.B.C. Play Registration

A.B.C Play! Registration Form
Sing Explore Create, LLC and Leading Therapy Home are teaming up to provide a unique supportive play opportunity to children 2.9-5! Facilitated by a board-certified music therapist (from Sing Explore Create’s team), as well as a speech language pathologist and/or occupational therapist (from Leading Therapy Home’s team), the group will be a fun and supportive environment that focuses on healthy child development and most importantly time to play and make new friends!
Thank you for your interest in participating in ABC Play! There are two major changes occurring during Semester 1 this year:
1. Sing Explore Create (SEC) is relocating at the end of October! The fall session will begin at SEC in Rockland (28 Webster Street). The week of October 30-November 3, we will transition to SEC in Hanover (33 Rockland Street/Route 139). The new Sing Explore Create will be just a few minutes away, and we're looking forward to having a larger space!
2. With this newer space, Sing Explore Create is able to offer an increased number of programs in 2023-2024. We want to make sure students are participating in the programs that are going to be most beneficial for them. Because of this, we will have an updated screening process for the school year. Please fill out this registration form as usual, and a member of our team will contact you if any additional information is needed, or if we believe another program would be a better fit for your child. You will receive an invoice via email when your spot in the group is confirmed. We want to make sure that everyone is in a program that is fun, motivating, and provides the most appropriate support for them to achieve their goals.
2023-2024 Schedule
- Morning Session - Wednesdays, 9:30-11:30am
- Afternoon Session - Wednesdays, 12:30-2:30pm
I am registering for...*
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Parent/Guardian's Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (to be contacted on day of class)*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Primary Language Spoken at Home*
A.B.C. Play is an integrated program that will benefit all children, including those who in need of support in any developmental areas. As with any program held at SEC, support staff (such as ABA therapists) are welcome to assist any child who needs 1:1 support to attend and participate in activities.

My child will not need additional support to sit and attend with the groupMy child will need additional support to participate in the group and an ABA therapist or other support person will accompany them.
Tell us about your child! We strive to create an environment in which all students can have fun, be comfortable playing during both structured and unstructured play time, and have a successful group experience. Please share anything you would like us to know about your child (personality, learning style, favorite activities, etc.). If you would like to discuss further, please don't hesitate to contact us directly via phone or email.*
Please select one:

I am a Leading Therapy Home client and am interested in discussing the option of using my insurance for the group.I will not be using insurance through Leading Therapy Home, and will pay tuition for ABC Play

Emergency Information

We collect medical information for all in-person and virtual services. The information provided would be used should we need to contact emergency services during your time with us.
Please list any allergies. Write "N/A" if none.*
Do you have an epi-pen?*

YesNo
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to Student*
Emergency Contact Phone*
Please enter a valid phone number.
Second Emergency Contact Name (Optional)

First NameLast Name
Second Emergency Contact Relation to Student (Optional)
Second Emergency Contact Phone (Optional)
Please enter a valid phone number.
Medical Attention

In the event of an emergency requiring medical attention, I understand that Sing Explore Create, LLC will make every effort to contact and notify the listed parent/guardian and emergency contact listed above. However, if neither can be reached Sing Explore Create, LLC reserves the right to call emergency personnel to transport the student/client to the nearest medical facility to secure necessary medical treatment. This applies to sessions at our center, at-home visits, and online sessions.
*

I have read and agree to the above statement regarding medical attention.
Pick-Up Policy: For students under age 18, we reserve the right to ask for picture identification from anyone picking up students from Sing Explore Create, LLC studios. Only those who have been given written permission from the students' parent/guardian will be allowed to pick up. Please list the names of those who may be picking up the student below. In the event that a student must be picked up by someone not listed below, hand-written notification and permission from the parent/guardian must be given to the teacher prior to the student being dismissed.*

A.B.C Play! Registration Form

Emergency Information

Media Permissions