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We are so excited for you to attend Muzique's Music Therapy classes at We Rock the Spectrum Northeast Philly! Please fill out the form below and we will notify you with the official start date!

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!

**If you have already attended a 6-week Muzique session at WRTS NE Philly, 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
This class is $125 for 6 weeks. You will be charged $125 for the class once you submit this form in order to hold your place. You will not be charged further without your consent.
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 NE Philly!

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 NE Philly and consent that Muzique may offically sign me up for the next round of 6-week classes! *
The music class at WRTS NE Philly is $125 for 6-weeks as of 03/01/18. By checking this box you are stating that you understand that Muzique will be charging your card $125 for the next 6-week class when this form is received.