Parental Agreement for Music Therapy
We, the parents of _________________________, agree to have him/her placed in the Music Therapy Program led by MaryBeth Allen MT-BC.
We understand that:
- Each session will be approximately _45_ minutes long, _1_x/wk., for a minimum of _8__weeks.
- To enhance the success of the program, we understand that we must work with our child _1x__/weekly, by practicing assigned exercises/lessons at home.
- Music Therapy tuition may be divided into monthly payments. (Individual-$200/mo., Group-$180/mo.) In addition to therapy tuition, there will be an annual assessment fee.
- Rates: $50-individual session (x8=$400) $45-group session. (x8=$360). Student absences will be made up only if time permits. Therapist absences, exceeding the two weeks, will be made up; snow days will not be made up, unless time permits. (Virtual sessions may be an option) Any other unforeseen absences, with regard to tuition adjustment, will be decided case by case.
- We understand that the Music Therapy Program is not an absolute cure for our child’s learning and/or emotional difficulties. We are aware that we may not see an immediate change in academic or emotional/cognitive achievement. The effectiveness of the program is closely linked with our child’s cooperation in therapy and with completion of home assignments.
- A music therapy goal or treatment plan will be provided at the end of the first month of services, and a progress report on a regular basis. The therapist/student ratio is generally 1:5 for group sessions but may be adapted according to the needs of the student.
By signing below,
_____ Accept - We acknowledge that we understand the information given and agree to the terms as stated in this agreement.
___________________________________________________________ Parent(s) Signature Date
___________________________________________________________
Music Therapy Program, Coordinator Date
Assessment Fee: $____50.00____
Music Therapy Program tuition: (please circle) Individual Group
Please indicate how many Sessions desired. 2 months, 4 months, 6 months, 8 months.
TOTAL $__________