Registration for Let's Make Music - 6 week Music Program for Individuals with Disabilities
Thank you for registering to participate in the six-week program. This program is sponsored by Culture Blocks— a community partnership funded by Mecklenburg County.

Questions on this form are to collect information in order to provide a report to the Arts & Science Council on enrollment numbers and assist the facilitator, Miss Ashley, Tisdale, MT-BC with tailoring the program. If you need assistance with this registration form, please call 803-206-2044 (no text messages possible) or email director@piedmontmusictherapy.com.

This group will meet weekly on Mondays at 4pm, beginning April 19th and conclude on May 24th with limited enrollment. The first 25 registrants will receive follow-up emails with information on the GoogleMeet platform to join the closed event, and details for picking up your material kit prior to the series beginning. After the group series is filled, registrants will be contacted for waitlist notification.
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Email *
Do we have permission to subscribe your email address to PMT Newsletters? *
Registrant's First Name *
Phone Number *
How did you learn about this event? *
If "Other" please describe how you learned about Culture Blocks:
Are you able to pick-up your instrument kit at the Charlotte Mecklenburg Library - West Blvd. Location? *
Do you have technology to access the 6-week series that will meet online Monday, 4-5pm (EST) 4/19/21 - 5/24/21? *
Do you reside in West Charlotte - Block 4? *
List emergency contact: Name & Phone Number *
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