Victory Chorus Participant Registration - Dementia Friendly Duluth

Participant Information

Participant Name*

First Last

Participant Address

Street Address Address Line 2 City State ZIP Code

Participant Phone

Participant Email

Do you have any allergies?*

Yes
No

Briefly describe allergies:

Voice Part*

Soprano
Alto
Bass

Please select the sessions you would like to register for:*

The Victory Chorus rehearsals are each Sunday afternoon from 1:30 to 3:30. The final Sunday of the session is the concert which requires a time commitment from 1:30 to 4:00.

Select All
2020 session 1 - January 12 to March 15
2020 session 2 - April 19 to June 28
2020 session 3 - September 13 to November 15

Photo Release*

The Victory Chorus story unfolds with each rehearsal, performance, and other interactions. In order to share our story with the community to encourage more people to participate, we will promote the Victory Chorus through photos, videos and other methods. With this in mind, we hope that each Volunteer, Participant, and Care Partner of the Victory Chorus will agree to be in photographs and videos that may result in their image being found in the public sphere.

Yes, I give my permission to the Victory Fund to include my image in any medium that may be used to describe or promote the Victory Chorus, which may include press releases, news media, social media, or other external digital or print publications or applications.
No, I do not agree to give permission to the Victory Fund to use my image.

How did you learn about the Victory Chorus?*

TV or Newspaper
Victory Chorus Performance
Social Media
Website
Referred by a Professional
Friend or Family
Other

Care Partner Information

Please provide the name and contact information of the care partner who will accompany you at the Victory Chorus activities.

Care Partner Name*

First Last

Care Partner Phone*

Care Partner Email

Care Partner's Role at Victory Chorus

Volunteer singer
Operations volunteer
Audience only

Emergency Contact Information

Is your Emergency Contact the same as your Care Partner at Victory Chorus?*

Yes
No

Emergency Contact Name

First Last

Emergency Contact Phone

Emergency Contact Email

Comments

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