Melinda's Music

Melinda's Music

ph: 845-477-0451

Registra- tion Form

 MELINDA’s MUSIC  is pleased to present our clients with the opportunity to experience the process of MUSIC THERAPY.  Music Therapy is the use of music, within a developing relationship between therapist and client, as a vehicle to assist with self-esteem, socialization skills, speech, motor skills and more.  A person who participates in a music therapy session need not have any previous musical experience or talent. 

MELINDA’s MUSIC utilizes community members who act as 1-1 volunteers with each child.  These volunteers (mostly teenagers) are interested in pursuing a vocation in a related field.  *Because these volunteers offer to share their spare time with your child, we ask that parents/caregivers PLEASE INFORM US AHEAD OF TIME IF THEIR CHILD IS TO BE ABSENT.  The volunteers are often very busy with school, work, etc.

Need  More Information? contact Melinda Burgard, M.A.,CMT, LCAT at: 845-477-0451

or E-mail: Melindasmusic@cs.com / Become a fan of “Melinda’s Music” on Facebook

   MUSIC THERAPY GROUP (lead by Melinda M. Burgard, M.A., LCAT, CMT):

  Mondays at 4:30pm and 5:30pm  9/20/10– 11/15/10  ages 3 - 9 yrs. and 14 – 19 yrs.                    

Please Note: Registration is on a first come, first served basis. Group size is LIMITED.     

 

Attn: NEW CLIENTS! IF this is your first time, before you send in this form,please call Melinda  to insure this is the appropriate group for your child*   (477-0451)

 

Tuition (8 wks):  $195* (plus 1 time reg./assessment fee of $25 for new clients)= $220       

      Make checks to: Melinda M. Burgard, PO Box 245, Greenwood Lake, NY 10925

      Payment is due BEFORE session begins.  There will be no refunds once class is in session. There is a $35 service fee for checks that do not clear.  Class size is limited.

      *DEDUCT $10 (ONLY) if  FULL PAYMENT IS RECEIVED BY 9/3/10*

MELINDA’S MUSIC THERAPY              WARWICK           MON               SP10

Parent/Caregiver___________________________________Phone#_________________

Address/City/State/zip_________________________________Cell phone#___________

E-mail Address ________________________________

Child’s Name(1)__________________Date of Birth___________________ Age_____

 Diagnosis______________________Any behaviors I should be aware of?__________

______________________________________________________________________

Child’s Favorite Songs/Musical Activities____________________________________

What goal do you see for your child in this group?______________________________

Class time__________________ Fee enclosed:_____________________

 

Please Note: PARENTS/CAREGIVERS MUST STAY on premises during sessions **Please SEND bottom of THIS FILLED-OUT  FORM WITH YOUR PAYMENT **

Copyright 2010 Melinda's Music. All rights reserved.

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Melinda's Music

ph: 845-477-0451