Vacation Music Jam Registration (Arc and SEC)

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Registration Form

February Vacation Music Jam!
Vacation MUSIC JAM & Caregiver Coffee!

2/16/25

Provided in partnership with:

The Arc of the South Shore's Autism Resource Center

Sing Explore Create, LLC

Join us for a school vacation week music jam session! Kids will play instruments, sing songs, dance, and rock out to some fun summer tunes! This program is specifically designed for children and teens with Autism and related disabilities, offering structured support and meaningful social engagement.

Music Jam workshops will be facilitated by Music Therapists from Sing Explore Create, LLC. The Autism Resource Center will provide additional staffing and program support.  While the kids are busy having fun, caregivers can join us in an adjoining room for a coffee! A relaxed chance to chat with other families and our Autism Supports team.

Location: Sing Explore Create, LLC (33 Rockland St. Hanover, MA 02339)

WHEN: Monday, February 16

Schedule

9:30-10:15      Group 1 (Ages 3-7)

10:30-11:15    Group 2 (Ages 8-12)

11:30-12:15    Group 3 (Ages 13-16)

Registration is required and space is limited.

Reach out to Bridget bdunn@arcsouthshore.org with questions.

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This is event is funded by a generous grant from

The Harold Brooks Foundation in Partnership with The Arc of the South Shore Autism Supports
Please select the program you are registering for at this time (limit 1 per submission)* *

Participant Information:
* Please submit one registration form per student you would like to enroll.
Parent/Caregiver's Name*

First NameLast Name
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Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Address*

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Groups are capped at 10 children. We will have 2-3 support staff in the room, in addition to the music therapist facilitating the group. If your child needs 1:1 support to safely participate in the music group, a caregiver, PCA, ABA therapist, or other caring adult are welcome to accompany your child in the group.*

My child will need 1:1 support and an adult will accompany them in the groupMy child will be able to participate with the staffing levels described above and will not have an adult accompany them in the group
Is there anything else you would like us to know about your child that will help us support their success in the group? (Ex: sound sensitivities, primary method of communication, etc.)
Emergency Information
Does your child have any allergies? Write "N/A" if none.*
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).
Please indicate your preference below:*

Yes - I give permission for Sing Explore Create, LLC and Arc of the South Shore to take pictures, videos, and audio recordings of myself/my child(ren).No - I do not give permission for any pictures, videos, or audio recordings of myself/my child(ren) to be taken.
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