Application

This is an application for funds as the become available, and at the discretion of Sound Movement Services. If you are not looking for funds but want to schedule with Erin Finkelstein, please contact her at 916-296-9068 or info@erinfinkelstein.com. This will serve as both an intake form, and application, but if you're looking for the intake form only, please visit www.erinfinkelstein.com/paperwork.

Personal Information

Today's Date *

Full Name*

Birthday*

Parents Names/Caretakers *

Parent Email*

Parent Phone *

Siblings and Ages *

Address*

Second Parent/Caretaker/Emergency Contact Name *

Email*

Phone*

Health and History Information

What brings you to the Feldenkrais Method for your child? How do you hope this will help? *

Have you done Feldenkrais® before?*

Hospitalizations and/or surgeries? *

Does your child have a diagnosis?*

What movements or situations have you been told not to do by a medical professional? *

What brings your child joy? *

Are there any triggering aversions to avoid? *

Is your child in a wheelchair, fed. by G-tube, or use any other kind of assisted device? *

What therapies are you in at the current moment? *

What therapies have you stopped, and why?*

Financial Information

Are you looking for ongoing local sessions, or an intensive of 5-10 lessons in a week? When are you hoping to have an intensive?*

What is your annual income range:*

$10,000 - $30,000

$30,000 - $50,000

$50,000 - $100,000

$100,000 +

Do you currently have access to any other funds: ESA, DDD income, trust funds, settlement funds or a way to get reimbursed for lessons?*

Do you anticipate having access to any of these other sources of funding at a future date, and if so, when?*

What months do you hope to do an intensive with me, or are you local and hope to have ongoing lessons?

Funds are distributed at the discretion of Sound Movement Services, and may be partial or full coverage of some lessons. Right now there are limited funds available, but we hope to help more people as time goes on.

By typing AGREE below, you agree that this information is accurate and up to date, and you agree to update Sound Movement Services if and when your financial situation changes. Not doing so may result in revocation of services.*

Who referred you to me, or where did you hear about my services?*

Social Media and my email list is a wonderful way to get the word out about this life-changing education. If you would like to take pictures and video in the lesson, please check with me first so I can review the content and ok it. You child's privacy is my top priority, so please choose the option that you are most comfortable with below. Additionally, I enjoy you sharing any videos or pictures you might have of our work together with me directly, so that I may keep a folder to view as your child works with me over the years. You can follow me on facebook.com/SoundMovementServices, ig @soundmovementservices, twitter @erinfinkelstein, LinkedIn https://www.linkedin.com/in/erinfinkelstein/

Social Media/Email List Preferences

Please never share any photos or videos of my child

Please check with me before sharing any photos or videos of my child

Feel free to share photos or videos under 30 seconds of my child

By submitting this form you understand that the Feldenkrais ® Method is an educational tool to increase somatic awareness, and assist in your child's learning how to achieve function movement through ease and joy. In no way does the Feldenkrais Method ® replace medical advice. In any movement modality there is an element of risk, and you hereby release Sound Movement Services from any liability.

Consent and release of liability

I Agree

By clicking below, you agree to the following cancelation policy: Lessons that are canceled in less than 48 hours (two full days) for any reasons other than illness or death in the family, will pay the full session fee. I often have a waiting list and families coming from out of town for lessons, so I want to ensure children and their families get the times they need.

Cancelation Policy

I agree

Anything else you'd like me to know?

Sound Movement Services Foundation