{Multi-Child Family} Registration - Music Therapy Connections

Select Your Session of Choice*

Mid Fall (October 22/23/24 – November 12/13/14)
Early Winter (January 7/8/9 – 28/29/30)
Mid Winter (February 11/12/13 – March 3/4/5)
Early Spring (March 17/18/19 – April 7/8/9)
Mid Spring (April 21/22/23 – May 12/13/14)

Select Your Class(es) of Choice*

Ages 0-3 // Tues AM (Rachel) // 9:30 am
Ages 0-3 // Tues AM (Rachel) // 10:30 am
Ages 0-3 // Wed AM (Emma) // 9:30 am
Ages 0-3 // Wed AM (Rachel) // 10:30 am
Ages 3-5 // Wed AM (Emma) // 10:30 am
Ages 0-3 // Wed PM (Emma) // 5:30 pm
Ages 3-5 // Wed PM (Becky) // 5:30 pm
Ages 3-5 // Thurs PM (Emma) // 5:15 pm

First Child's Name*

First Last

First Child's Date of Birth*

Second Child's Name*

First Last

Second Child's Date of Birth*

Third Child's Name

(if applicable)

First Last

Third Child's Date of Birth

(if applicable)

Your Name*

First Last

Email*

Phone*

Photo & Video Release*

Photos and videos may be used for promotional purposes on our website, social media, and print materials. If you do not grant permission, photos and videos of your children will not be used outside of class for any reason.

Special Considerations

Please list any allergies, special needs, or other issues so that your children can be best served during the course of this class.