Music Therapy

@ Carmel High School (C-3 Partnership)

MONTHLY PAYMENTS

By filling out and submitting this form, you will be charged $35.00/month automatically for a total of 5 months.
If you would like to set up a one-time payment for the semester, please click here.

"*" indicates required fields

Student's Name*

First Last

Student's Birthdate*

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:*

Monthly payments will be deducted every 30 days until May 2023.

Payments - $35.00/month

Total

Payment Method

Explore our additional services here:

INDIVIDUAL MUSIC THERAPY | GROUP MUSIC THERAPY | EVENTS & CLASSES | PRESENTATIONS & WORKSHOPS

Want to know more? Have additional questions? Contact us for a consultation.