Registration for Free Father's Day Program

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for registering to participate in this virtual event!

This program will meet on June 23 at changed time of 6:00pm, socially distanced outdoors at 1820 Eden Terrace in Rock Hill, SC 29730.

This event is not open to the public - families will have to pre-register and honor social distancing requirements. Material kits will be distributed in the provided seats. In the event of rain, families will need to pick-up their material kit on Wednesday morning, June 23 between 10am - Noon via curbside pickup at 1820 Eden Terrace, Rock Hill, SC 29730.

After the event is filled, registrants will be contacted for waitlist notification.

Questions on this form are to collect information in order to provide a report to the Arts Council of York County and SC Arts Commission.

The info will also assist the facilitator, Mrs. Melissa Reinhardt, MSEd MT-BC, Neurologic Music Therapist 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.

*We will also reach out after the event to request your feedback to evaluate the funded opportunity per ACYC & SC Arts Commission guidelines.

Email *

Do we have permission to subscribe your email address to PMT Newsletters? *

Yes

Family Contact: First & Last Name *

How did you learn about this event? *

Social Media Post

Family/Friend messaged me

Other

If "Other" please describe how you learned about the Mother's Day Virtual Music Event:

Do you reside in York County, SC? *

Yes

Are you able to pick-up your instrument kit in Rock Hill on 6/23 between 10am - Noon in the event of inclement weather/rain? *

Yes

Information requested by SC Arts Commission and the National Endowment for the Arts - Please identify your race:

African American

American Indian/Alaskan Native

Asian/Pacific Islander

Hispanic

White (not Hispanic)

Clear selection

List emergency contact for the virtual program dependent on weather: Name & Phone Number *

Clear form

Never submit passwords through Google Forms.

This form was created inside of Piedmont Music Therapy. Report Abuse

Forms