2017 Music Therapy Summer Camp
This camp is for children with special needs (e.g: autism, cerebral palsy, Down syndrome, etc.)

July 4th - 8th VCM Downtown, 900 Johnson Street (Tuesday - Saturday)
July 10th - 14th VCM Langford, 210 - 1314 Lakepoint Way (in the new Y at Westhills building)
July 17th - 21st Nanaimo Conservatory of Music, 375 Selby Street


* Participant must be accompanied by a caregiver at all times during the sessions *


ONLY registrations submitted online will be considered. We no longer accept hard copy registration forms.

You will receive an e-mail confirmation of your session's week and time a few days after submitting your registration form. Please check your inbox. This camp is on a first come first served basis. We will be gathering a waiting list, as needed.

This is a very high demand camp with limited enrolment, please be kind and inform Dr. Johanne Brodeur immediately if you are unable to join the week camp as we will be able to invite another child to join. brodeur@vcm.bc.ca.

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Child's Full Name:
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Parent's/Guardian's Full Name:
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Address:
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Participant's date of birth (MM/DD/YY) as of July 1st 2017
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The participant will attend the week of:
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SECOND CHOICE for participant's class time:
Attending adult (if different from Guardian):
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Diagnosis:
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Additional Comments (if applicable, please share with us if your child has a seizure disorder and describe any additional information that will help us to work with your child during the camp (eg: details on visual and/or hearing impairment, physical limitations, etc.):
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Communication Model:
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My Child is:
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Behaviour Triggers:
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Preschool/School/Daycare attended:
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Other professional education and/or health practitioners in child's life:
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Allergies, behavioral issues and/or special notes:
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Has your child been in a group therapy program prior to this Music Therapy Summer camp?
Please state 2 short-term goals that you would like to be addressed for your child during the sessions:
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