Gregory Chase Music Studio
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    • Lessons 1 - 10 >
      • Class #1 - Sept 16/17
      • Class #2 - Sept 23/24
      • Class #3 - Sept 30/Oct 1
      • Class #4 - Oct 7/8
      • Class #5 - Oct 14/15
      • Class #6 - Oct 21/22
      • Class #7 - Oct 28/29
      • Class #8 - Nov 4/5
      • Class #9 - Nov 11/12
      • Class #10 - Nov 18/19
    • Lessons 11 - 20 >
      • Class #11 - Nov 25/26
      • Class #12 - Dec 2/3
      • Class #14 - Jan 6/7
      • Class #15 - Jan 13/14
      • Class #16 - Jan 20/21
      • Class #17 - Jan 27/28
      • Class #18 - Feb 3/4
      • Class #19 - Feb 10/11
      • Class #20 - Feb 24/25
    • Lessons 21 - 30 >
      • Class #21 - Mar 3/4
      • Class #22 - Mar 10/11
      • Class #23 - Mar 17/18
      • Class #24 - Mar 24/25
      • Class #25 - Mar 31/April 1
      • Class #26 - April 14/15
      • Class #27 - April 21/22
      • Class #28 - April 28/29
      • Class #29 & #30 - May 5/6 & 12/13
    • Tonal & Rhythm Patterns
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Parent and Child Information Form


    Parent's Information


    Primary Address:

    About Your Child
    Note that the day is not required. The only reason this is asked is that it is helpful for us to know where your child is developmentally.

    The following information will help us as we work with  your child.  Please share what you are comfortable in sharing.  The more we know about your child, the more effective we can be in our music sessions. 
    Has, or is, your child receiving other therapy or training sessions?  If so, please list them below.  If they occurred in the past please indicate when:
    Has your child been or in the process of a diagnosis?  If so, what was the outcome? Or what lead you to seek a diagnosis?
    Is there any other Information we should know about your child?

    We look forward to working with you and your child.

    ​When finished, click submit and you will receive a notification that your information has been submitted.
Submit
Contact us:

Email
Phone: (306) 761-0277
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