Music Therapy

@ Carmel High School (Interns and Surveyors)

MONTHLY PAYMENTS

By filling out and submitting this form, you will be charged $40.00/month automatically for a total of 4 months.
If you would like to set up a one-time payment for the semester, please click here.

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Student's Name*
Student's Birthdate*
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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 needs, allergies, or other issues so that your student can be best served.
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Monthly payments will be deducted every 30 days until December 2023.
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