Carmel High School C-3 Partnership (WEEKLY) - Dynamic Music Services, Inc.

Carmel High School C-3 Partnership

Weekly Payments

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

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

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

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.
Complete your registration:*
After submitting the form, you will be directed to PayPal for your payment.
- Pay per session ($10/session)
Total
$0.00