Carmel High School C-3 Partnership (month-to-month autopay)

Carmel High School C-3 Partnership

Set up an automatic monthly payment

Music therapy sessions will be taking place on the following dates:

Sessions will be led by our team of board certified music therapists (MT-BCs).

Cost: $30.00 per month (if you would like to pay in full, click here)
Monthly payment will be deducted every 30 days.

Student's Name*
First Last
Student's Birthdate*
Month
Day
Year
Parent/Caregiver's Name*
First Last
Address*
Street Address Address Line 2 City State Zip code
Email*
Phone*
Photo & Video Release*
Photos and videos may be used for promotional purposes on our website, social media, and print materials. If you do not grant permission, photos and videos of your student will not be used outside of class for any reason.
Please list any special considerations
Please list any special needs, allergies, or other issues so that your student can be best served.
Please indicate when your student will attend:*
- Select All
- January 12, 19, and 26, 2022
- February 2, 9, 16, and 23, 2022
- March 2, 9, 16, 23, and 30, 2022
- April 13, 20, and 27, 2022
- May 4, 11, and 18, 2022
Complete your registration:*
Monthly payments will be deducted every 30 days until May 2022. After submitting the form, you will be directed to PayPal for your payment.
- Payments - $30/month
Total
$0.00