Meet a Musician Friendship Program Music Interest Form

Welcome to Meet a Musician Friendship Program... a program which aims to bring together musical artists and seniors and their caregivers to foster friendship through a shared love of music.

Please take a couple of minutes to fill out this Music Interest Form – for the Musical Artist to better understand what type of music has influenced your life. Please feel free to bring along any music memorabilia to the session.

Full Name:

My Preferred Name:

Phone Number

Email Address

Languages I Speak:

My Age:

<65 65-75 75-85 85<

Accommodation Type:

Privately-owned or rental property Retirement Village Aged Care Facility

Rep Name:

Rep Relationship:

Rep Phone Number

Rep Email Address

Relevant physical, psychological, behavioural, emotional, expressive, or social needs (i.e. hard of hearing, communicates non-verbally, requires support from a care person to participate etc.):

I would like the musical artist to engage ME in music in the following ways:

Singing to music Listening to music Moving to music Play an instrument together Relaxing with music Help me to discuss memories attached to music

Other/ Comments

My Favourite Style/s of Music:

Classical Jazz Blues Rock ‘n’ Roll Folk Heavy Rock / Metal Pop Reggae Country Disco Orchestra Opera Musical Theatre Hip Hop RnB Soul World

Other/ Comments

My Favourite Singers / Bands:

Elvis Presley Abba Neil Diamond Everly Brothers The Eagles Fleetwood Mac John Denver The Bee Gees Aretha Franklin

Other/ Comments

My Favourite Music Era/s:

20s, 30s, 40s e.g. Louis Armstrong, Frank Sinatra 50s e.g. Elvis Presley, Dean Martin 60s e.g. The Beatles, Beach Boys 70s e.g. Led Zeppelin, Pink Floyd 80s e.g. Bruce Springsteen, Queen 90s e.g. U2, Nirvana 2000+ e.g. Coldplay, Red Hot Chilli Peppers

Other/ Comments

My Favourite Composers:

Bach Beethoven Chopin I'm not into classical music

Other/ Comments

My Favourite Instrumentals / Musicals:

Sound of Music Grease Westside Story Cabaret Rocky Horror Picture Show Moulin Rouge Cats

My Favourite songs:

My Favourite Instruments:

Other/ Comments

Our mission

Is to enhance the lives of seniors through the delivery of innovative programs that promote well-being.

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Staff Cabinet
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Staff Cabinet
Manage My Bookings

In the spirit of reconciliation Meet a Musician acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea, and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today

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