Mobile Music Therapy Service
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Music Lessons
‘Taster’ Sessions with Āhuru Mōwai Trust
School Registration
Contact
Register your student
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Your name
*
First
Last
Role/ Title
*
School/ Organisation Name
*
Your contact email
*
Your phone number
*
Preferred contact method
Email
Phone
SMS/ Text
(We will contact you via email in the first instance unless you indicate otherwise.)
Service requested
*
Individual music therapy (1:1 onsite)
Open play-based group facilitation (ECE/ early primary)
Small child-led group facilitation
School Multi-Session Block (Half-Day or Full-Day)
Consultation or Advisory Support
Select all that apply
Desired location
*
Caravan Onsite - Minimum 3 x 1:1 sessions (Requires level parking, turning space & power access)
Quiet Indoor School Room Provided Onsite
Mana Therapy Hub or Kāpiti Studio
Telehealth / Online
Not applicable - for consultations and workshops
Select all that apply
Individual student referral?
*
Yes
No
Name of student
First
Last
Age and year level
Is this student currently accessing music therapy anywhere else?
No
Yes
Please note that in compliance with Music Therapy New Zealand's Code of Ethics, we do not generally work with participants who are already working with another music therapist. However, from time to time it may be possible to work in collaboration with another music therapist where the service provisions differ.
Caregiver name
First
Last
Student's strengths, Interests & Musical Passions
(What brings this child joy? Favourite songs, instruments, or ways of engaging?)
Support Areas & Focus
(e.g. regulation, communication, peer connection, sensory wellbeing, transition support)
Sensory, Communication & Physical Considerations
(e.g. prefers quiet spaces, uses AAC, sensory preferences/sensitivities, mobility needs)
Group facilitation
*
Yes
No
Target age group/ year level
Estimated number of tamariki
Group goals & focus areas
(e.g. social play, turn-taking, transition support, open musical exploration)
Proposed funding pathway
School/ ECE budget allocation
Ministry of Education / ORS Funding
Agency Contract
Billed Directly to whānau (Individualised Funding, Carer Support, or Private)
Unsure / Requiring Guidance
Preferred time/ days
Professional Collaboration Consent: I confirm that initial consent has been obtained from the whānau of the student(s) to share this information for referral purposes.
Yes
No
Pending discussion
Please note that music therapy can only go ahead with caregiver permission.
Comment
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