Name *

First Name

Last Name

Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Volunteer Interests

Special Note: We do not accept volunteers to engage directly in client services unless referred from an accredited music therapy program.

General Administration

Technology Support

Marketing & Outreach

Fundraising Assistance

Event Assistance

Creative Arts Support

Facility Maintenance

Other

Emergency Contact Information *

First Name

Last Name

Phone Number *

(###)

###

####

Relationship to Volunteer *

Parent-Child

Sibling

Spouse/Partner

Extended Family

Roommate

Other