Grand Band for Adults | Music Therapy in Motion, LLC

Mondays from 10:00-10:45AM

Band Member's Name*
First Last
Band Member's Age*
Caregiver's Name(s)
First Last
Caregiver's Email
Caregiver's Phone
Photo/Video/Audio Consent*
Photos, video, or audio may be taken during Grand Band and may be used for education and training purposes (i.e., clinical supervision, conference presentations). They may also be used by Music Therapy in Motion, LLC for advertisement purposes (i.e., brochures, website, social media, and newspapers). If you do not grant permission, photos and videos of the band member will not be used outside of class for any reason.
- Yes, I do grant permission.
- No, I do not grant permission.
Indicate how many sessions you would like to pay for at this time:*
Price: $10.00 Quantity:
Total
When you click on Submit & Pay, you will be automatically redirected to PayPal to complete your registration. Please email us if you experience problems registering!
$0.00