Saturday Groups for February
No group January 10th
Child's Name
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Please note that a parent, guardian, or appropriate therapist must accompany your child to the group and remain with them for the duration of the group. Are you able to provide this support?
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Please tell me 2-3 things you hope group music therapy will help with:
Dates (no group February 21st)
*
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February 7th
$
30.00
February 14th
$
30.00
February 28
$
30.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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