FMT Summer 2023 Registration and Payment Form

Family Music Time

Sept - Dec 2023 Registration and Payment Form
Welcome! Let's get started. Select one:*

Register for class(es)Purchase instrument kit(s). We have already registered for class.

Family Information

A 'family’ unit = 1 or 2 adult caregivers with up to 3 children.
How many adult caregivers in your family unit?*
How many children in your family unit?*
Child #1 Name*

First NameLast Name
Child #1 Birth Date*

MonthDayYear
Child #2 Name

First NameLast Name
Child #2 Birth Date

MonthDayYear
Child #3 Name

First NameLast Name
Child #3 Birth Date

MonthDayYear
Adult Caregiver #1 Name*

First NameLast Name
Relationship to Child/Children*
Cell Number*
E-mail*
example@example.com
Adult Caregiver #2 Name

First NameLast Name
Relationship to Child/Children
Cell Number
E-mail
example@example.com
Parent/Guardian Information
Same as 'Adult Caregiver #1'

YesNo
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Parent/Guardian permission to use photos and/or videos of child/children for marketing purposes by Sound Inspirations Music Therapy, LLC*

yesno
Permission to be contacted regarding future children's services*

yesno
Emergency Information

Please list an emergency contact other than the adult caregiver attendee
Emergency Contact's Name*

First NameLast Name
Relationship to Child/Children*
Phone Number*

Instrument/materials Kits:

An optional purchase, listed after the class dates in the "Purchase Options" section.

2023 is the last year we will offer these kits at such a low rate due to the sourcing of the instruments and movement props. Purchase of a kit is not required for participation in class as the facilitator will bring a collection of comparable instruments and props for families to borrow if they do not have their own kit. The original idea of having the kits stemmed from an infection control mindset during 2020. Positive benefits of purchasing a kit for a child may include but are not limited to extending the musical activities at home; fostering creative expression at home; a sense of self-confidence through ownership; a source of motivation; empowerment to participate on the child's terms and timing during classes; increased infection control by reducing the exposure risk of the kit items; a transition tool for the child regarding returning to future classes.
Did you participate in Family Music Time classes in 2021 or 2022?*

Yes, we are returning participants from 2021-2022.No, 2023 is our first year here.
Did you buy an instrument kit in 2021 or 2022? If so, add the FREE Bonus item!

Thank you, I already updated my kit with the bonus item!Yes, I will select the $0 option below the classes to add wrist ribbons to my kit!No, I didn't buy a Family Music Time instrument kit in 2021 or 2022

Family Music Time

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