Music & Memory Program Consent Letter

We have an incredible new program - Music & Memory - that will bring joy and happiness to those in our care.

Music & Memory is a nonprofit that provides personalized music training for long term care organizations. The approach is simple. We hope to engage all our program participants and learn their favorite music from when they were a teenager. Studies have shown that a playlist of such favorites will offer a number of therapeutic benefits to the listener, the family, and allstaff involved in the process. Here’s a wonderful video that shows the benefits of the Music & Memory program: musicandmemory.org.

If you are interested in taking part in our Music & Memory program, please sign and date this form below. Authorized family members may also give consent for someone to participate in the program. Please note:

• You can withdraw from the program at any time by contacting nursing home staff and speaking with the Music & Memory coordinator.
• All equipment utilized is the property of our organization and would need to be returned should a participant withdraw from the program.

If you have questions, please ask the Music & Memory coordinator. For more information about Music & Memory, visit www.musicandmemory.org.