Music Resiliency A Path to Wellness: For First Responders and Their Families
The purpose of this form is to register for our upcoming music resiliency and wellness series to support first responders, their significant others, and their children/families.  Now is your chance to connect with yourself and your loved ones and to explore new pathways to health and wellness.  Step into this wellness journey together and deepen your bond with your family through music...BECAUSE YOU ARE WORTH IT! You continuous give to your community, allow your community to support you and your family through this journey.

We will provide exercises for you and your family to do on your own time and then come together once a month for a music and wellness experience together.  Allow this journey to support your re-entry, yourself, and your loved ones.

This series is designed to work around your busy lifestyle and schedule to support and incorporate wellness into your daily lives and connections.

We will be in touch shortly after you submit this form with more information!

* In order to participate in these groups virtually or in person, you must complete this registration form.  You will be contacted via email weekly with information for the groups including details (location, etc.), reminders, resources, and our zoom link, for those of you joining us virtually.  Please make sure you keep an eye out for emails both before and after group each week.  

Please contact Ashley Iverson, ashley@iversonfaa.org or Rachel Gant, rgant@resoundingjoyinc.org for more information.
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First and Last Name *
Your Phone Number *
Your Email *
Your Zip code (needed for grant reporting) *
Your Age Range *
Are you interested in attending the group virtually or in person? *
What Agency is you First Responder in? *
If you answered "other" to the above question please specify the department with which you are associated.
Which City, State, Department/Unit/or Station are you from? For example, San Diego, Ca; Cal Fire MMU or San Diego City Fire *
Do you have a significant other that will joining you for our music resiliency groups?
 *
Do you have children that will joining you for our music resiliency groups? *
If you responded "yes" to the above question, please specify the name and age of each of your children joining us. *
What is your comfort level making music with your family? (0-not comfortable at all, 5-most comfortable) *
Where would you rate your current feeling of stress and anxiety? (0=no anxiety, 5-Most anxiety) *
What do you hope to gain and expect from these groups?  What brings you here? *
What do you hope your children gain from these resources/groups? *
Do you have any previous music experience?  If yes, please specify.
Do you have any accessibility considerations you would like us to accommodate? *
If "yes" above please specify your needs.
Does your child(ren) have any accessibility considerations you would like us to accommodate? *
If "yes" above, please specify your child(ren)'s needs.
Do you currently have access to services meeting these needs already? *
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