Registration Music & Me SY2022-23

Music & Me - SY2022-23

(For children ages birth to 5 with visual impairment or 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.Format: (000) 000-0000.
Child Attending *

First NameLast Name
Child's Age*
Cortical Visual Impairment (CVI)BlindLow visionCombined hearing and vision loss or deaf-blindOther
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 - SY2022-23