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MAM Mentoring Participant Interest Form 
Is your child (or you) interested in learning music? 

Whether they want to tackle a new instrument or hone their skills on their current instrument, Music as Medicine (non-profit organization) provides highly qualified high school student mentors from all over the Houston area help guide your child! All students in Grade 1 and up are eligible to participate in our mentorship program.

After you fill out this form, you will receive an email with more specifics and a link to our booking website for free lessons! 

Thank you for your interest in Music as Medicine's mentoring program!
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Email *
Name of Parent/Guardian 
Phone Number *
Name of Participant *
Grade Level of Participant (2023-2024 School Year) *
Lesson Format Preference *
Instrument of Interest 
*Please note that for learning woodwind and horn instruments, you will need to explore rentals - with our help and suggestions if needed. 
* Due to sizing, you will also need to explore rentals for learning string instruments 
* The participant is also welcome to solely observe during the lessons 
 *
Skill Level of Selected Instrument  *
Access to Instrument  *
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