Registration Music & Me SY2021-22

Music & Me - SY2021-22

(For children ages birth to 3 with developmental delays or disabilities to include children with visual impairment and combined hearing and visual loss or deaf-blind.)
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone number*
Please enter a valid phone number.
Child Attending the Playgroup*

First NameLast Name
Child's Age*
Does your child have*

Cortical Visual Impairment (CVI)BlindLow visionCombined hearing and vision loss or deaf-blindOther
Do you need any accommodations?

ASL InterpreterOther
Request for accommodations must be provided a week before the event to give us time to locate interpreters or prepare other accommodation requests. Thank you.

Questions? Please email: kansasdeafblind@kssdb.org
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Music & Me - SY2021-22