Rock Band Enrollment Form

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“Give me the beat to free my soul"

Do you remember the first time you experienced music that shook you to your core? "Rock Band!" is a place where kids can be free to be who they are. No apologies. No "quiet down". Just rocking out. This small group learning environment is a social experience encouraging students to create, manage, and develop their very own band. Students will learn Piano, Guitar, Drums, Vocal Skills, and even create their own songs!

INTRODUCING 4 WEEK SUMMER SESSIONS!!

45 minute groups

Cost: $110 per session

Bradenton:

Summer I: 6/4-6/25

Summer II: 7/9-7/30

Buffalo:

Summer I: 7/1-7/26

Summer II: 8/5-8/30

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LOCATIONS:

Bloom Creative Arts Southtowns Office and Therapy Space:
3377 Lake Shore Rd. Blasdell, NY 14219

Bloom Creative Arts Northtowns Office and Therapy Space:

5684 Main St. Rear Building Williamsville, NY 14221

Bloom Creative Arts Florida Office and Therapy Space:

842 62nd Street Circle East Unit 105 Bradenton, FL 34208

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SESSION DAY/TIMES:

Bradenton, FL:

Tuesdays

3-5 yo: 3:00-3:45pm

6-8 yo: 4:00-4:45pm

Buffalo Southtowns:

Mondays

6-8yo: 4:00- 4:45pm

Buffalo Northtowns:

Mondays

6-8yo: 4:30-5:15pm

One payment of $110 is due by the first class and can be paid via Venmo or invoiced through Quickbooks.

A late payment fee may be assessed for outstanding balances.
Children are expected to attend weekly, and missed sessions will not be reimbursed.
Music runs for 4 weeks, 45 minutes per week.

Please confirm the session/location you are registering for: *

Bradenton, FL- Summer I 3-5 year olds

Bradenton, FL- Summer II 3-5 year olds

Bradenton, FL- Summer I 6-8 year olds

Bradenton, FL- Summer II 6-8 year olds

Buffalo (South)- Summer I 6-8yo 4-4:45pm

Buffalo (South)- Summer II 6-8yo 4-4:45pm

Buffalo (North) Summer I 6-8yo 4:30-5:15pm

Buffalo (North) Summer II 6-8yo 4:40-5:15pm

Child's Name *

Date of Birth *

YYYY

Address *

Main Phone Number *

Secondary Phone Number (If applicable)

Email *

What is your preference? *

Phone Call

Text Message

Other:

Please list Parent/Guardian names below.

Promo code

I would like to pay via:

Venmo @bloomcreativearts

Quickbooks (invoice will be sent to provided email address)

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Music addresses many different areas of development. Please indicate any areas of need, or areas you would like to work on with your child, and detail any additional information. Examples may be counting, colors, balance, clapping, etc.

Social/Emotional: Peer play, attention to task, impulse control, cooperative play, engaging in activities, etc:

Motor: Fine and gross motor skills such as grasp (pincer/palmer), balance, coordination:

Communication: effective expressive language skills, volume and tone, articulation:

Academic: Pattern recognition, following multi-step directives, math concepts:

Recreation: Enjoys music, dancing, sings, hums, previously participated in music, etc.

By signing below I acknowledge the above payment and attendance policy. *

How did you hear about us?

Bloom Creative Arts sends newsletters to caregivers highlighting progress and uses photos from weekly sessions. Sharing photos on our social media pages and www.bloomcreativearts.com allows the community to view the fun we engage in at class. Please indicate below your preference for photo release permission. Contact Information: info@bloomcreativearts.com (716) 422-0070 *

Yes, I do consent to photos being used in Bloom's newsletters and social media.

No, I do not consent to photos being used in Bloom's newsletters and social media.

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