Community Class Registration

Music For Everyday Life - Lagond Music

Community Class Registration - Single Session
Community Class Schedule
Name

First NameLast Name
Preferred nickname:
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Have you signed up for an EE Music Class before?

Accessibility & Support Needs
Do you use any mobility aids?
If "yes", check all that apply:

Other
If "other", could you share more?
Do you use any mobility aids?
If "yes, what do you use?
Are there any specific accommodations or supports that would help you fully participate?
Medical & Safety Information

*Only if relevant for participation
Allergies (food, environmental, medication):
Medications (if necessary for staff awareness):
Seizure history or other medical considerations:
Any restrictions or health concerns EE should be aware of?
Emergency Contact & Support Information
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Secondary Emergency Contact

(Optional)
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Support Staff (if applicable)

(e.g., DSP, Case Manager, Family Member)
Name

First NameLast Name
Role
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Music for Everyday Life

90-minute Community Class

$75.00 Quantity

Total

Music For Everyday Life - Lagond Music