Music Resiliency: A Family Experience
The purpose of this form is to register for our upcoming music resiliency series to support first responder significant others and their children/families. Now is your chance to learn how to play an instrument (ukulele), learn some fun songs just for you and bond with your family through music...BECAUSE YOU ARE WORTH IT!

We will have breakfast snacks and coffee available during our meet and greet time prior to starting then we’ll be splitting up adult and kids groups to support your whole family unit.

Groups will be held Saturday mornings from 9:00-11:00am, starting Saturday, September 25th, for 8 weeks. We will be in touch shortly after you submit this form with more information!

* In order to participate in these groups virtually or in person, you must complete this registration form. You will be contacted via email weekly with information for the groups including details (location, etc.), reminders, resources, and our zoom link, for those of you joining us virtually. Please make sure you keep an eye out for emails both before and after group each week.

Please contact Ashley Iverson, or Rachel Gant, for more information.
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First and Last Name *
Your Phone Number *
Your Email *
Your Zip code (needed for grant reporting) *
Your Age Range *
Will you be attending in-person or virtually? *
What Agency is you First Responder in? *
If you answered "other" to the above question please specify the department with which you are associated.
If you answered “Fire Department”, which department/unit? For example, Cal Fire MMU or San Diego City Fire *
Please select your ukulele option for this series. *
Do you have children that will joining you for our music resiliency groups? *
If you responded "yes" to the above question, please specify the name and age of each of your children joining us. *
What is your comfort level making music with your family? (0-not comfortable at all, 5-most comfortable) *
Where would you rate your current feeling of anxiety? (0=no anxiety, 5-Most anxiety) *
What do you hope to gain and expect from these groups? What brings you here? *
What do you hope your children gain from these groups? *
Do you have any previous music experience? If yes, please specify.
Do you have any previous experience playing ukulele? If yes, please specify.
Do you have any accessibility considerations you would like us to accommodate? *
If "yes" above please specify your needs.
Does your child(ren) have any accessibility considerations you would like us to accommodate? *
If "yes" above, please specify your child(ren)'s needs.
Do you currently have access to services meeting these needs already? *
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