Amy Winehouse Foundation Music Therapy Intensive Summer Block

Please complete this form to register your interest in attending the Amy Winehouse Foundation Music Therapy Programme, taking place between 16 – 26 August You can find full information about the programme here: https://cpotential.org.uk/amy-winehouse-foundation-music-therapy/

Thank you for completing the form. We will be in touch with you soon with further details.

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* 1. Please provide your contact details (must complete all fields)

Your full name

Child’s full name

Child’s date of birth

Email address

Phone number

Postcode

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* 2. There are limited places available on the summer intensive block, but please let us know your preferences with timings and we’ll do our best to accommodate:

Morning session

Afternoon session

Amy Winehouse Foundation Music Therapy Intensive Summer Block

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* 1. Please provide your contact details (must complete all fields)

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* 2. There are limited places available on the summer intensive block, but please let us know your preferences with timings and we’ll do our best to accommodate:

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* 3. The programme will run from the 16th - 26th August. Please let us know if there are any dates that you cannot attend:

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* 4. Please let us know if your child has a diagnosis and list any areas of your child’s development that you would like support with:

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* 5. Please use this section for any additional comments or questions: