Momentum Choir Registration

What is your name? *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Birth Date *

MM

DD

YYYY

Do you require technology (i.e. an iPad or something other) to participate in the choir?

Yes

No

Do you have a primary care giver? If so, share their name and contact information here.

First Name

Last Name

Primary Caregiver's Phone

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact's Phone *

(###)

###

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Consent to Photos and Videos *

Momentum Choir would like to post videos and photos of the choir and choir members on our website and social media pages. Do you give Momentum Choir consent to post videos and photos that may include you?

Yes

No

Do you agree to have emails sent to you? *

Yes

No

Yes, for both my caregiver and I

Do you agree to stay home if you are not feeling well? *

To minimize the potential to spread sickness, we ask that our members stay home on the days they're not feeling well. If you arrive to practice or a performance while you are sick, you may be asked to leave. By clicking "yes," you are acknowledging that you have read and understood this policy.

Yes

No