Register your child

If you have any questions before registering your child for music therapy with the Little Musical Caravan, you can read our FAQs page or contact us for further information.

FAQs

Contact me

Please register your interest in music therapy services for your child here:

Child's Name *

First

Last

Date of Birth *

Year and School, or indicate if homeschooled

Teacher and room number (if applicable)

Parent/ Caregiver 1 *

First

Last

Email *

Address *

Daytime telephone number *

Parent/ Caregiver 2 (if applicable)

First

Last

Address (if different)

Daytime telephone number

What are your child's strengths and interests? *

What hopes do you have for your child? *

What music does your child enjoy?

Does your child already play an instrument? If so, please give details.

What is the reason for referral? (This might be a formal diagnosis or a description of challenges your child experiences.) Please include details of any specific medical needs. *

Is there any more information you would like to share?

Does you child have any access needs? If so, please give details.

Does your child or any of your child's immediate family have health needs which place them in a high risk category for COVID-19? If so please give details or contact me directly. *

Where did you hear about us? *

Name