Music Healing Veterans Canada Intake Form

Where Words Fail, Music Speaks

Hans Christian Anderson


Though a little lengthy, please take the time to fill out this form. 


Your information will be forwarded to the chapter you indicate is the closest to you, and you will soon be contacted by that chapter with further instructions and information on how to begin your journey.


Please note, although we would love to be able to provide instruction to everybody, we do not have the resources, nor are we equipped to do so. Therefore, our focus must remain with those that are dealing with injuries. 


PRIVACY: The information you submit is treated as confidential and will never be shared with anybody outside of the Music Healing Veterans board members, or intake representatives.

Please enable JavaScript in your browser to complete this form.
Are you applying as
Tell us about Yourself
What is your preferred method of contact?
If you have a Facebook profile and would prefer to be contacted that way please enter your Facebook profile in the box below
What is/was your occupation?
If you checked the 'Other' category please specify your occupation in the field below
What is your current status?
Where do you live? (So we can try and link you to the closest chapter)
Do you live with an Operational Stress Injury (OSI), such as PTSD. etc?
Anything at all, no matter how big or small it may seem.
Arthritis, Diabetes, Epilepsy, Mobility Assistance, etc.
Have you played any instruments previously?
What instrument are you interested in learning? Your local chapter may have other instruction to offer.
If you checked 'Other' please enter your preference in the field below
For those interested in guitar - are you right or left handed?
Do you own the instrument you currently wish to learn?
With the exception of our website we do most of our communications and updates through Facebook. Do you currently have a Facebook Account?
Do we have your permission to use your picture (taken during meetings and events) for our social media marketing?



Music Healing Veterans Canada has a ZERO-TOLERANCE policy when it comes to harassment, violence or aggression of any kind. We are here to always provide a safe environment for both students and instructors.


Failure to follow the zero-tolerance policy will result in an IMMEDIATE removal from the program.


  • Respect each other.
  • Absolutely no drama.
  • No war stories, this program is about healing through music.
  • No foul language. Classes may be held at various facilities (churches, legions, etc.) and we must represent the program, Veterans, First Responders and Medical Professionals in a positive manner.
  • Smoking and the use of alternate medicine is permitted in designated locations only. Place all cigarette butts in the provided receptacles, and please be respectful of any requests of those that run the facility you are using.
  • Please notify your instructor or Chapter Manager if you cannot attend a meeting;
  • If you have a private lesson and you cannot attend, please notify your Instructor and the Program Director as much in advance as possible.
  • Our beginner program offers a loaner instrument system (mainly guitars). If you decide you no longer wish to take part in the program, please return the instrument you have on loan.
  • Have fun!