New Student Registration - Music Therapy Connections

Adult Student or Parent*

First Last

Email*

Phone*

Student (if under 18)*

First Last

Date of Birth*

Registering for:*

Student 2 (if under 18)

First Last

Date of Birth

Registering for:

Availability*

Lessons and music therapy sessions are typically offered Monday-Friday between the hours of 9 am and 7 pm. Additionally, we have limited hours on Saturday mornings. Please list ALL days and times during which you/your student is available for scheduling.

Additional Information

Feel free to provide any pertinent information regarding student's experience, specific goals, preferred days/times, special needs or considerations, etc.