Class Registration

courtney@roadstorhythmmusictherapy.com

1.204.513.1906

Birthdate: *

Parent(s) Name: *

Which program would you like to register for? *

Address: *

To register for one of our classes, please fill out the following form. Please provide as much detail as possible.

Cell Phone: *

Family Email: *

Child's Name: *

Home Phone: *

Please select class payment option below. Payment can be made by e-transfer. E-transfers can be sent to courtney@roadstorhythmmusictherapy.com *

City: *