2024-2025 Plymouth County Family Support Registration

If you encounter any technical difficulties or other issues while filling out this form, please notify us at admin@singexplorecreate.com.
Registration Form

Music and Creative Arts Wellness at Sing Explore Create, LLC
Sing Explore Create, LLC is providing a Music Therapy and Creative Arts Wellness program sponsored by Plymouth County Family Support. This program is graciously funded by DDS. All adults who are currently served by DDS are invited to participate. The information you provide below will be shared with Sing Explore Create, LLC and Plymouth County Family Support.

The next session begins on Tuesday, February 4th and concludes on June 17th. Class will be held weekly on Tuesdays from 10:30-11:30am. There will be no class on February 18th or April 22nd.

If you have questions about your eligibility, please contact Emily at emilyw@pcfamilysupport.org. If you have any other questions about the program, please contact Amanda at admin@singexplorecreate.com

Please note: All classes will be held at 33 Rockland Street Hanover, MA 02339.
Please select one of the following:*
If the program is full but you are interested in participating in the future, please select "Join The Waitlist" and complete the registration form. If anyone withdraws from the program, we will contact you!
Participant's Name*

First NameLast Name
Participant's Date of Birth*

MonthDayYear
Date
Primary Contact Person OR Parent/Guardian's Name*

First NameLast Name
What is your relation to the participant?
Phone Number (to be contacted on day of class)*
Please enter a valid phone number.
Email*
example@example.com
Will there be a caregiver accompanying the participant in the group? (PCAs are welcome for anyone who may need assistance participating!)
Accommodations: We strive to create an environment in which all participants feel comfortable getting creative and have a successful class experience. Please share any other information you would like us to know to ensure a successful experience or you can write "call me" and we will contact you for more information. You may write "N/A" if no accommodations are needed.
Emergency Information
Please list any allergies. Write "N/A" if none.*
Does the participant have an epi-pen?*

YesNo
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to Participant*
Emergency Contact Phone*
Please enter a valid phone number.
Second Emergency Contact Name (Optional)

First NameLast Name
Second Emergency Contact Relation to Participant (Optional)
Second Emergency Contact Phone (Optional)
Please enter a valid phone number.
Media Permissions

At times we may take pictures, videos, and audio recordings during classes/sessions. We utilize recorded media for marketing and professional development purposes. For marketing, recorded media may be shared to our website, professional Facebook page, and used to produce other marketing materials (brochures, newspaper articles, etc). For professional development, recorded media is viewed by staff members at Sing Explore Create for educational purposes. Please indicate your preferences below:
Please indicate your preference below:*

Yes - I give permission for Sing Explore Create, LLC to take pictures, videos, and audio recordings of the participant.No - I do not give permission for any pictures, videos, or audio recordings of the participant to be taken.
SEC Newsletter

Please click the box below if you would like be informed of any upcoming programs or events at our center.
Newsletter

Yes, subscribe me to this newsletter.
HOW DID YOU HEAR ABOUT US?

Social MediaGoogle SearchRecommended by a friend/family memberMet us at an eventReferred by a Community Resource (school, healthcare provider, library, etc.)Other
By clicking "Submit", you are signing {participantsName} up for the entirety of the session (February 4-June 17).

This program focuses on building community, establishing connections with others, and building skills. To achieve these goals, participant attendance is vital. We ask that participants attend all classes and arrive on time. Once registered, you are commited to the remainder of the session. If a participant is continually absent or late, we reserve the right to release their spot in the group to participants on our waitlist.

Please contact admin@singexplorecreate.com if you have any questions regarding our policies.
Should be Empty:

Registration Form

Emergency Information

Media Permissions

SEC Newsletter