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We are so excited for you to attend Muzique's Music Therapy classes at We Rock the Spectrum Mt. laurel!

MUZIQUE MUSIC CLASSES ARE INCLUSIVE FOR ALL ABILITIES. WE WILL FOCUS ON DEVELOPMENTALLY APPROPRIATE GOALS SUCH AS SOCIAL SKILLS, SPEECH AND LANGUAGE SKILLS, MOTOR SKILLS AND SO MUCH MORE! IF THIS SOUNDS LIKE SOMETHING YOUR CHILD COULD BENEFIT FROM, THEN MAKE SURE TO REGISTER THEM NOW!

FOr just $175, you will receive a 6 class pass that can be used within 2 months of purchase! CLasses are Sundays at 10:30AM or __________. You are welcome to attend either just one class a week or even both, the choice is yours! THis cost includes 15 minutes of open play before or after each class you attend!

**Run out of sessions on your 6-class pass? EASY FIX! If you have already purchased a 6-week Muzique session pass at WRTS Mt. Laurel and would like to get another pass for 6 more sessions, please scroll down to fill out Form 2!**

FORM 1

Parent/Guardian Name *
Parent/Guardian Name
Cell Phone Number *
Cell Phone Number
Child's Name *
Child's Name
Child's Birthdate *
Child's Birthdate
A 6-session pass for Muzique Music Class is $175! By completing this form, you will be charged $175 for the 6 class pass, which you can use within 2 months of purchase! You will not be charged further without your consent. This class price includes 15 minutes of open play!
Expiration Date *
Expiration Date

FORM 2

Please fill out this Form 2 ONLY IF you have previously filled out Form 1 for a prior Muzique Music Class at WRTS Mt. Laurel!

Parent/Guardian Name *
Parent/Guardian Name
Cell Phone Number *
Cell Phone Number
Child's Name *
Child's Name
I am going to continue with another Muzique Music Class at WRTS Mt. Laurel and consent that Muzique may officially sign me up for another 6-class pass! *
By checking this box you are stating that you understand that Muzique will be charging your card for $175 when this form is received.