Summer Social Skills Group Registration
One of our music therapists will contact you within 24-48 hours upon submission of this form. Any information shared on this form will remain confidential, as per standard HIPPA requirements.

Please feel free to reach out to Julia anytime at: julia@wildflower-mt.com. 

Payment may be made via Venmo (@Julia-Sims-7) or check before or at the time of each group. If an alternative payment schedule is needed, please let us know- we are flexible! 
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Email *
Name of Participant: *
Age *
Gender *
Parent/ Guardian Name *
Parent/Guardian Phone Number *
Preferred Method(s) of Contact *
Required
What date(s) will you attend the Social Skills Group?  *
Required
What are some of your favorite songs? (Participant)
Are there any specific needs of which we (the WMT team) need to be made aware? (e.g., Autism Spectrum Disorder, Cerebral Palsy, etc.) Please elaborate. This will help us better plan each session!
Is there anything else you would like us to know?
During Wildflower Music Therapy camp sessions, we may take photos and/or videos. Do we have permission to use photos and/or videos of your camp friend for future marketing and/or educational materials? *
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