MUSIC LESSONS - Developing Melodies Pediatric Therapy and Music Learning

Developing Melodies offers weekly music lessons for beginner ukulele and piano. Each lesson includes 30 of instruction with an experienced music instructor. Each lesson will be tailored to the learning wants and needs of the individual.

For those who succeed best using creative and unique approaches to learning, our lessons incorporate creativity designed to specifically meet the learning needs and challenges of each individual student, while maximizing their strengths and abilities.

Student Lesson Inquiry and Agreement

Looking to learn more about music lessons for your child? Please complete the inquiry and agreement form below to the best of your ability. Once you submit this form, our director will contact you when a lesson time is available. If you are seeking other services or have other questions, please contact our center director Meryl Brown at Meryl@DevelopingMelodies.com.

Personal Information

Student Name(Required)

First Last

Student Pronouns

Student Birthdate(Required)

MM slash DD slash YYYY

Student Age(Required)

Please enter a number from 0 to 18.

Choose an Instrument

Ukulele

Piano

Parent/Guardian Name(Required)

First Last

Relationship to Student(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Secondary Phone

Emergency Information

Emergency Contact Name(Required)

First Last

Emergency Contact Number(Required)

Relationship to Student(Required)

Student Information

Student's Current School or Early Learning Program(Required)

Grade Level(Required)

Tell us about some things that are motivating for the student.(Required)

ie. positive praise, stickers, smiles, high fives, snack rewards, TV shows, games, movies, etc.

Tell us about any challenges or needs for your child that our instructors should know about.(Required)

ie. challenges in turn-taking, reactions to loud sounds, not yet reading, eloping, transitions, etc.

Developing Melodies Policies and Procedures

Who We Are(Required)

Developing Melodies seeks to provide outstanding music learning experiences, support and communication to prospective and current students and their families. We strive to curate a safe and nurturing environment that is accessible, warm, positive and well informed. At Developing Melodies we seek to meet the needs of all people of all abilities in an inclusive and collaborative way with the intention of cultivating self-directed outcomes and growth.

I have read the Who We Are statement.

Non-Discrimination Policy(Required)

All therapists and staff at Developing Melodies seek to meet the needs of all people of all abilities without discrimination of any kind including but not limited to: sexual orientation, race, color, national origin, gender, sex, age, religion or disability.

I have read the non-discrimination policy.

Lesson Rates(Required)

Our services include so much more than the time spent with students directly. Your lesson rate covers all of the following: • Preparation Time • Lesson or Session Time • Communication with parents/families • Documentation of services • Developmental of teaching/therapy materials • Therapist and Educator Training and experience • Special Event Cost and Preparation • Professional Association Membership • Continuing Education and Certification Costs • Center Expenses: Cleaning Supplies, Virtual Platforms and other expenses associated with having lessons. Additional Expenses may occur as follows: • Music Books, downloads and materials- billed to you as needed, copies receipts may be shared

I have read the lesson rates description.

Payment Procedure and Policy(Required)

Payment is due upon receipt of monthly invoice unless previously arranged, in writing, with Developing Melodies. Invoices are sent electronically. Acceptable forms of payment include cash, check (Made out to "Developing Melodies") or electronically through the invoice system. Payments may be mailed to "Developing Melodies, 705 E Lincoln St. Suite 209, Normal IL 61761". Payments are considered late if not paid within 14 days of invoice date. Late payments will incur a $20 fee. If payments are not received by the next invoice, a student may be removed from the instructor's schedule until all payments are received, thus possibly forfeiting their time slot. Returned checks for any reason will incur an immediate $25 fee and any associated bank fees in addition to the total amount due.

I have read the payment procedure and policy.

Attendance Policy(Required)

Your consistent and prompt attendance is expected on your designated day and time of your lesson unless previously arranged with your instructor. Please notify your therapist at least 24 hours prior to an absence. If you have an early AM lesson we kindly ask that you call or text your instructor the night before (or text as early as possible that morning) to give them notice of an absence. No shows with no call ahead will incur a full session fee charge. In the case that your instructor is absent for any reason, they will communicate their absence to you as soon as possible and you will not be charged for their absence. Make up sessions are scheduled on a case by case basis.

I have read the attendance policy outlined above.

Media Release(Required)

Photos of students and video/audio recordings or student projects and performances may be posted online and used by the instructor for promotional and workshop materials. Identifying information will be excluded. Parents wishing to exempt their students from any published media may do so.

Yes, I give permission for photographs and recordings.

No, I do not give permission for photographs and recordings.

Weather Policy(Required)

Unsafe weather is unfortunately inevitable in Central Illinois. In the case that lessons are canceled on your lesson day due to unsafe weather conditions or an emergency, your instructor will contact you as soon as possible to cancel your session. You will not be charged for canceled lessons due to unsafe weather conditions or emergencies. Make up lessons for unsafe weather cancellations will be scheduled on a case by case basis.

I have read the weather policy outlined above.

Waiver of Liability(Required)

In consideration of participation of this event with Developing Melodies, I hereby waive, release and discharge any and all claims for damage for personal injury, death or property damage which I, or my child, may have, or which may hereafter accrue to me, as a result of participation in activities at said facilities. It is understood that activities such as the ones I will be participating in, involve an element of risk and danger of accidents and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold harmless, Developing Melodies, its officers, employees and agents from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in any activity at this or any other Developing Melodies facility.

I have read the waiver of liability outlined above.

Agreement: (If under 18, Guardian of student signature required)

By typing my name (Electronic Signature), I am agreeing to the policies outlined above. Following receipt of this agreement, I understand that I am able to pursue lessons with Developing Melodies and that individuals from Developing Melodies may contact me to schedule lessons accordingly. *If under 18, Guardian of student/client signature required.*

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