The Art of Music LLC

Make sure to fill something out in every field with a red asterisk*. The form will not submit unless there is something in every *required field, and if you leave the form before submitting it successfully, you will have to start the form over.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Child's Date of Birth *

Is your child enrolled in school? *

Yes No

If "Yes", Please Provide School Name & Grade Level *

Name of individuals who have permission to drop off/pick up child *

Emergency Contacts (Include Relationship to Child and Phone Number) *

Do you plan to stay with your child during the sessions? *

Yes No

If "No", please provide a contact number where we may reach you (if necessary). *

Does your child have any serious behavior concerns we need to be aware of? *

Goals you have for your child(ren) for this session (i.e. cognitive, behavioral, social, etc.): *

How would you like us to contact you regarding class information? (Cell phone, text, email, home phone, etc.)? *

Payment Options *

Private Pay in full by Mail Private Pay $25 Deposit (Balance Due on 1st Day of Class) Paypal (Payment Links Above) PAS - from a Service Coordinator or Support Administrator DSACO (Individual with DS)

We like to take photos during our sessions. These photos are only for our records, the website, Facebook and/or promotional materials. Your child's name will NOT be used in any material. May I include your child in these photos? *

Yes No

If other, please specify. *

Note: If inclement weather is an issue, our policy is to cancel class if there is a Level 2 weather emergency. We will then reschedule a makeup class at the end of the session.

​"Christmas Fun 2021"​3-Week Art of Music Session​Starting in November/December of 2021

Sign Up for our Next Art of Music 3-Week Session

"Christmas Fun 2021"
3-Week Art of Music Session
Starting in November/December of 2021