Gift_Growers_Parent_Permission

Gift Growers Music Therapy Program

Parent/Guardian Permission Form Empowering students through music, expression, and emotional growth.

Student Name*

Grade*

School*

Program Description Gift Growers is a music therapy-based program that helps students explore their emotions, build confidence, and strengthen social skills through music. Activities include rhythm games, songwriting, calming sound exercises, and group collaboration. Sessions are led by trained facilitators and designed to be engaging, therapeutic, and fun.

ParentGuardian Name*

Phone Number*

Email Address*

example@example.com

Emergency Contact if different*

Emergency Phone Number*

The form allows you to opt in or out of photo/video permissions for documentation and promotional use. Your child’s safety, privacy, and well-being are our top priority. Please select one*

I give permission for photos or videos of my child to be taken during sessions for documentation and promotional purposes.I do not give permission for my child to be photographed or recorded.

Please check all that apply*

I give permission for my child to participate in the Gift Growers Music Therapy Program.I understand that music-based emotional activities will be included, and all content is age-appropriate.

ParentGuardian Signature*

Date*

Date