Summer Recreational Music Registration

Use the form below to register for a summer recreational music group.

For more details about each group, visit musictherapy.westmusic.com/summer-recreational-music

Iowa City: Rock the Summer
Quad Cities: Bucket Beats

Thank you for your interest in a summer recreational music group! You will receive an email 2 weeks prior to the group starting date with additional details, or cancellation information if necessary.

Contact Name(Required)

Family or coordinator completing this form.

First Last

Contact Email(Required)

Contact Phone

Participant Information

Participant Name(Required)

Only one registrant per form.

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Quantity(Required)

Photo Release

By signing below, I authorize West Music Co. to use the participant’s photograph or audio/visual recordings in conjunction with name (or fictitious name) in any medium that West Music sees fit for purposes of advertising, display exhibition, editorial use, employee training, or education and advocacy. I affirm that I have the legal right to issue such consent. I further understand that no royalty, fee, or other compensation of any kind shall become payable by West Music Company.

Provide Consent(Required)

I am authorized to provide consent, and I have read and agree to the photo release.

I am not authorized to provide consent. I will provide an email address for an authorized contact.

Signature(Required)

Provide an email address(Required)

Who can we contact to receive consent for photos?

Program Selection & Payment

If cost is a barrier to participation, please email musictherapyservices@westmusic.com to discuss financial assistance options.

Select your program(Required)

Choose the program you wish to register for.

Quad Cities: Bucket Beats (Tuesdays starting June 2)

Iowa City: Rock the Summer (Wednesdays starting June 17)

Total

Payment Choice(Required)

Pay now by credit card.

Email musictherapyservices@westmusic.com to set up another payment plan.

Credit Card

Card Details

Cardholder Name

"The goal of SoundReach Choir is being here together making music."

5 - SoundReach

"SoundReach Choir is just really about the joy of music!"

4 - SoundReach

"[The director of SoundReach Choir] makes everyone feel special & welcome."

3 - SoundReach

"[The directors of SoundReach Choir] have a tremendous variety of approaches to music, so that whatever the ability of the participant, he or she can be fully involved in the activity."

2 - SoundReach

"SoundReach means a lot to me. It helps me not give up and encourages me. And I like the music!"

Summer Recreational Music Registration

Use the form below to register for a summer recreational music group.

For more details about each group, visit musictherapy.westmusic.com/summer-recreational-music