Self-Aware Project Sign-up Form

Self-Aware Project Sign-up Form
Self-Aware Project

Definition

The Self-Aware Project  builds emotional intelligence and creates awareness of feelings in young children, adults, educators and preschool directors.

Why

Our focus is on the whole child to foster brain development and nurture discipline through joy and rhythms.

How

The Self-Aware Project will be brought to you by the m.a.r.y. foundation in two parts...

1. A matching grant for preschools - Grantees to be determined upon receiving applications.

2. A free monthly virtual drum circle for the community via Zoom

When

Preschools may apply beginning September 29, 2021.

Where

The Self-Aware Project will feature a drum session in the preschool classroom.

A free monthly, virtual Drum Day will be offered for the community via Zoom.



Mastering patterns and rhythms build the brain through drumming!

Although this class may be therapeutic, none of the activities during the class are psychotherapy or a substitute for psychotherapy.
Your name - who is filling out this form? *

First Name Last Name
Email *
example@example.com
Preschool Name *
Preschool Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Preschool Director's Name? *

First Name Last Name
Best Contact Phone Number

Area Code Phone Number
Text Number

Area Code Phone Number
How many children total at your school? *
How many classrooms total at your school? *
How many children in each classroom? *
How many teachers in each classroom? *
How many children of each age at your school? If none, put zero *
Where did you hear about our Self-Aware Project? Please click all that apply *

Friend Project SAFE Grandparent SA6 Mindful Veteran Project CDI Preschool teacher YCIC Another preschool Instagram REMO Facebook UCLArts & Healing LA Parent Magazine VA Vocational Rehabilitation Department Hathaway Child Family Services
What motivates you to apply for the Self-Aware Project? Please click all that apply *

To drum / love drumming Matching grant/School pays half the rate Curious / try something new Sounds like FUN Love the Drum to LEARN program Wanting a developmental experience for our children
What are you hoping to take away from this experience? Please click all that apply *

Participate in a fun activity Learning drum rhythms Social Emotional learning (SEL) Brain building for our children Emotional Intelligence learning (EI)
Have you drummed with Drum to LEARN, Inc. before? *

Yes No
Are photographs allowed to be taken during the drum circle? If yes, please click YES and also the consent button *

YES No
CONSENT, WAIVER, AND RELEASE OF LIABILITY FOR Drum to LEARN, Inc. VIDEOCONFRENCING EVENT

By joining, attending and participating in this videoconferencing event, you grant consent to the release, publication, exhibition or reproduction of your image, likeness, or representation, including, without limitation, photographs and audio/video recordings, to be used for news, webcasts, promotional purposes, telecasts, advertising, inclusion in websites, or any other marketing or related purposes to increase public awareness and promote continuation and improvements of this educational program of Drum to LEARN, Inc., and its affiliates and representatives. You waive all rights you may have to any claims for payment or royalties in connection with any exhibition, streaming, televising or any other publication of this video conferencing event, regardless of the purpose or sponsoring of such exhibiting, broadcasting or other publication irrespective of whether a fee for admission or sponsorship is charged. You fully understand that your consent is given for you and any participants as a condition and pre-requisite to your attendance and participation at this videoconferencing or in-person event.
Thank you for your support and interest!

We will truly appreciate your feedback with a POST follow-up survey.

This response will help us to meet your needs in the future.

Please keep a look out for the post survey after the drum class.
Any questions or comments?
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