KMA 2025 Music Therapy Enrolment Form
STUDENT INFORMATION
Full Name
Preferred Name:
DOB
Gender:
Male
Female
Other
Pronouns
He/Him
She/Her
They/Them
Other
Select Preferred time:
Please Select
Monday 9.45am - 10.15am (PRIVATE) BOOKED OUT
Monday 10.15am - 11am (GROUP)
Monday 11am - 11.30am (PRIVATE)
Saturday 1pm - 1.45pm (GROUP) 4 spots left
Saturday 2pm - 2.30pm (PRIVATE) BOOKED OUT
Saturday 2.30pm - 3pm (PRIVATE) BOOKED OUT
Allergies/Medical conditions/Learning needs
If so, list medications/care procedure (or attach Action plan)
Creative Kids Voucher Number (If Applicable):
PARENT INFORMATION
Name
Email
*
example@example.com
Contact no.
*
Upload Diagnosis and NDIS Care Plan:
How did you hear about us?
Please Select
Facebook
Instagram
Website
A Friend
Other
Options for payment of fees:
Full term payment via direct transfer (no fees)
Full term payment via credit card (once off 1.75% fee)
Fortnightly direct debit (1% + 0.40 cents per transaction)
Disclaimer:
I have read and agree to the KMA Student Policy.
I
understand that I am to collect my child from the studio immediately after their session.
Signed
Submit
Should be Empty: