Music Therapy Registration Form

Music Therapy Registration Form

At KYCC Recovery Services, by Rhythm and Truth
This is an registration form for weekly music therapy workshop for youth. Participants are not required to attend all workshops. No instruments or experience necessary!

Please answer all required questions.

You must provide emergency contact in order to register. You will receive a phone call to confirm registration.

Sessions are at 3727 W. 6th St., Suite 411, Los Angeles, CA 90020

Fridays from 4 PM - 5 PM
My Name

First NameLast Name
Age
My Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I would like to participate on the following dates (please choose one or more):
Should be Empty: