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 Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

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

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

Cortical Visual Impairment (CVI) Blind Low vision Combined hearing and vision loss or deaf-blind Other
Do you need any accommodations?

ASL Interpreter Other
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