Music Therapy Group Registration

Music Therapy Group Registration

For students with disabilities looking to connect with peers, develop social/communication skills, and have a fun space to express themselves in a creative way.
I am registering for...*
Check the box below if you are re-enrolling a current participant for the next session of this group.

I am re-enrolling a current participant.
You have selected that you would like to register for a music therapy social group not listed above. These groups are formed based on interest from the community. Groups will be scheduled once we have at least 5 participants of similar ages, abilities, and interests enrolled.

The information you provide on this registration form will help us determine which group will be the best fit for you. If you have any questions, please feel free to contact Amanda at admin@singexplorecreate.com.

Click "Next" to continue.

Medical 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.
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.

Medical Information