Registration for Music Therapy

Registering Your Child

Did you know that if your child qualifies for Program Unit Funding (PUF) or Mild Moderate Funding they get to participate in the Online MaxECS music therapy program for free?

MaxECS will be offering the opportunity for your child to participate in online group music therapy sessions! Music therapy is covered under PUF or Mild Moderate funding for a nominal fee, however, Music therapy sessions will not affect or take away from the funding hours you receive for other therapies such as speech therapy, physiotherapy, psychology, or occupational therapy.

The music therapy program has been created to provide an additional therapeutic service for your child to work on their IPP goals that are established by your child’s multidisciplinary team. In addition to providing an extra opportunity to work on IPP based goals, music therapy sessions count towards the required programming hours.

Music therapy sessions occur on a weekly basis during the school calendar year. Activities will include singing, songwriting, musical games, and moving to music. These activities aim to promote social interaction, improve language and communication skills, improve gross and fine motor coordination, increase creative self-expression, increase sensory stimulation, and address academic and life skills.

If your Certificated Teacher mentioned music therapy it is likely because the program your child is registered in doesn’t offer enough hours to be in compliance with Alberta Education funding hours. This is a great way to make up some of those hours. Please fill out the registration and consent form below. Please note that registration is on-going, and you may register your child for music therapy at any point throughout the year if they qualify for PUF or Mild Moderate funding.

If you have any additional questions or concerns about music therapy or funding please do not hesitate to contact Lauree Lavoie by email at lauree@maxecs.net.

Fill Out The Form Below To Register Your Child

"*" indicates required fields

Parent / Guardian

Parent / Guardian Name*

Email*

Phone*

Child's Name*

Child's Age (As of August 31)*

Child's Diagnosis

Certified Teacher

Educational Assistant Name

Does your child attend daycare/dayhome or preschool?*

What day(s) of the week does your child attend preschool/daycare/dayhome?*

What time during the day does your child attend preschool/daycare/dayhome?*

I am confirming that I am registering for Saturday morning sessions.*

Yes

Consent to Participate in LIVE Online Music Therapy Sessions & Consent For Release of Information

MaxECS LIVE Online Music Therapy group sessions will be administered by Zoom Professional. Zoom Professional is a paid service through zoom.us that provides the administrator (meeting host) with advanced meeting controls to enable encryption. Encryption provides an extra level of security within the meeting. Each meeting will be password protected and each user will be placed in a waiting room to be accepted into the meeting by the host. Each family has the right to choose if they would like to have their video camera on or off, or their microphone on or off during the meeting. Sessions will not be recorded or stored in any way through the meeting host or through zoom.us. Below is a summary of Zoom's privacy statement. To see the full privacy statement please visit: https://zoom.us/privacy.

Please review the Summary of Zoom Privacy Statement and Risks of MaxECS Music Therapy LIVE Online Music Therapy Sessions at the end of this form.

By signing this form you consent to the participation of your child in LIVE Online music therapy sessions with the music therapist, Julie Lowry for the current school year.

I understand that I may withdraw consent at any time, either verbally or in writing.

Please check the box next to the activity you give consent for your child to participate in:

Audio Recording can include but is not limited to the creation of recordings using recording software Garageband), mix C.D’s, radio plays, etc.

Video Recording can include but is not limited to the creation of a music video, musicals, etc

Photographs for in classroom use.

I authorize the music therapist to release verbal and written information regarding my child’s participation in music therapy in order to support the efforts of those providing services to my child. The music therapist may share my child’s information with the following professionals:*

Teachers

Assistant

Therapy Team Members including: Speech Language Pathologist, Occupational Therapist, Physiotherapist, Behavioural Consultant, Psychologist

You consent to the participation of your child in LIVE Online music therapy sessions with the music therapist, Julie Lowery effective upon registration.*

I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for the use of the selected electronic communications as described below. I understand and accept the risks outlined below in this consent form, associated with the use of electronic communications with the Service Provider. I consent to the conditions and will follow the instructions outlined above, as well as any other conditions that the Service Provider may impose regarding electronic communications with student families participating in LIVE Online Music Therapy sessions. I acknowledge and agree to communicate with the Service Provider or the Service Provider’s staff using these electronic communications with a full understanding of the risks in doing so. I confirm that any questions that I may have regarding the provision of healthcare services through electronic communications will be answered by the Service Provider. I understand that I can withdraw my consent at any time through written notice to Julie Lowry effective until June 30, 2024.

Parent/Guardian Signature*

CAPTCHA

If you have any questions or concerns please lauree@maxecs.net

Summary of Zoom Privacy Statement

Zoom only stores basic information under your account profile information: e-mail address, user password, first & last name
Zoom does not sell your personal data
Meetings are not monitored or stored when meetings are complete. If the hosts decide to record the meeting every user entering the meeting room is notified. Music therapy sessions will not be recorded.
Zoom only collects user data that is required for zoom services.
This includes technical and operational support and service improvement. For example, we collect information such as a user’s IP address and iOS device details to deliver the best possible Zoom experience regardless of how and from where you join.
Zoom does not sell customer content to anyone or use it for any advertising purposes.

Risk of MaxECS Music Therapy LIVE Online Music Therapy Sessions:

While the Service Provider will use reasonable means to protect the security and confidentiality of information sent and received using electronic communications, because of the risks outlined below, the Service Provider cannot guarantee the security and confidentiality of electronic communications:

The use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties.
Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.
Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
Electronic communications are subject to disruptions beyond the control of the Service Provider that may prevent the Service Provider from being able to provide services
Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Service Provider or the patient.
Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.
Electronic communications may be disclosed in accordance with a duty to report or a court order.
Videoconferencing using no cost, publicly available services may be more open to interception than other forms of videoconferencing.
There may be limitations in the services that can be provided through electronic communications, dependent on the means of electronic communications being utilized
Email, text messages, and instant messages can more easily be misdirected, resulting in an increased risk of being received by unintended and unknown recipients.
Email, text messages and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender or to ensure that only the recipient can read the message once it has been sent.
I acknowledge the risk that zoom.us Zoom Professional is not PIPEDA compliant but no documents will be stored through this service provider and all sessions will be password protected, all participants will be accepted by admin into the meeting through a waiting room and each video conference meeting will be encrypted.

I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for the use of the selected electronic communications as described above. I understand and accept the risks outlined above to this consent form, associated with the use of electronic communications with the Service Provider. I consent to the conditions and will follow the instructions outlined above, as well as any other conditions that the Service Provider may impose regarding electronic communications with student families participating in LIVE Online Music Therapy sessions. I acknowledge and agree to communicate with the Service Provider or the Service Provider’s staff using these electronic communications with a full understanding of the risks in doing so. I confirm that any questions that I may have regarding the provision of healthcare services through electronic communications can will be answered by the Service Provider.

I understand that I can withdraw my consent at any time through written notice to Lauree Lavoie at lauree@maxecs.net.