Learning Through Music Registration Form

Learning Through Music: Pre-K and Kindergarten

Registration Form
This inclusive group is fully online via Zoom.

The cost is $200 per 8 class series (sibling rate $100).

Class rate includes tuition; CD/download of music; a book, scarf, and instrument; activity ideas to use with your child at home; and access to our Empowering Wellness Initiative while enrolled in classes.

Learn more at: https://www.livingspirittherapy.com/learning-through-music/
Child Information
Note: If multiple children are enrolling in classes please fill out child information
separately for both children. Children with disabilities are welcome!
Child Name #1

First Name Last Name
Age
Birthdate

Month Day Year
Date
Gender

Male Female
Any relevant diagnosis, personality, or developmental information and/or special needs/
Child Name #2

First Name Last Name
Age
Birthdate

Month Day Year
Date
Gender

Male Female
Any relevant diagnosis, personality, or developmental information and/or special needs/
Parent Information
Name

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Caregiver Information

(If someone other than a parent will be bringing child to classes)
Name

First Name Last Name
Relationship to Child
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Class Locations and Schedule

All classes will be held virtually due to the COVID-19 pandemic.
How do virtual sessions work?
- Virtual sessions require a smart tv, iPad, computer, or another devise that can connect to a browser on the internet.
- We use a HIPPA compliant version of Zoom.
- Upon payment of the registration fee you will receive a link to enter into your browser to connect to classes.
Rates and Discounts
$200 per 8 class series

Current discounts and promotions:
- Registration fees are being waived during the COVID-19 pandemic.
- The sibling rate for additional children if two or more children are registered for classes the same semester is $100.
Payment

Payment is due by the first day of class.
Class Cost(s) Total
Total Due
Payment Method

Credit Card Check
Please contact Melissa Spiess at melissa@livingspirittherapy.com for the address to mail checks.
How Did You Hear About This Group?
Should be Empty:

Learning Through Music: Pre-K and Kindergarten

Child Information

Parent Information

Caregiver Information

Class Locations and Schedule

Rates and Discounts

Payment