Registration for Virtual Bucket Drumming 101- 6 week Series
Thank you for registering to participate in the six-week program. Please note, if you participated in the 1st series - this is a duplicated course that is offered twice for more students to participate.

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, Ms. Ashley, Tisdale, MT-BC with tailoring the program and Mary Kiefriter, MT Intern.

This group will meet weekly on Wednesdays, 5-5:45pm, beginning November 3, 2021 and conclude on December 15, 2021.  The first 20 registrants will receive follow-up emails with information on the GoogleMeet platform to join the closed event, AND details for picking up your instrument/materials kit prior to the series beginning. After the group series is filled, registrants will be contacted for waitlist notification.

If you need assistance with this registration form, please call 803-206-2044 (no text messages possible) or email director@piedmontmusictherapy.com.
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Email *
Do we have permission to subscribe your email address to PMT Newsletters? *
Registrant's First Name *
Registrant's Age (this is geared for children 8-14 years): *
Phone Number *
How did you learn about this event? *
If "Other" please describe how you learned about Culture Blocks:
Which location is closest to your home for picking up your free material kit? *
Do you have technology to access the 6-week series that will meet online Wednesdays, 5-5:45pm (EST) 11/3/21 - 12/15/21 (one week of for Thanksgiving Holiday)? *
What is your zip code in Charlotte? *
List emergency contact: Name & Phone Number *
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