Lincoln Center Moments
Thank you for your interest in Lincoln Center Moments, a performance-based program for people with dementia and their caregivers. Please fill out the following registration information, and select the programs which interest you.
First name of participant with dementia:
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Last name of participant with dementia:
Your answer
First name of caregiver:
Your answer
Last name of caregiver:
Your answer
I would like our tickets to be held under:
Email address of caregiver/group organizer:
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Contact phone number of caregiver/group organizer:
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What is the caregiver's relationship to the participant? (ex. Son, Daughter, Health Aide, Spouse, etc.)
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First and Last Names of any additional participants and relationship to primary participant:
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Total number in your group:
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If possible, please describe what kind of dementia the participant has (Alzheimer's Disease, Lewy Body Dementia, early stage, middle stage, late stage):
Your answer
Please tell us about any accommodations that your group might need:
Is there anything else we should know regarding accommodations for your group?
Your answer
Please tell us about you or your participant's experience with Lincoln Center and you or your participant's experience with performing arts:
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How often do you attend concerts with the participant with dementia?
How often do you attend art programs (example: museum tours, community center programs, library programs) with the participant with dementia?
Please share any experience or background that you would like us to know about the participant (career, passions, hometown)
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How did you hear about this program?
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Is there anything else that you would like to share about anyone in your group?
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Please select the dates and programs that you are available for and interested in attending:
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Each performance lasts one hour, and is followed by an hour-long social and art-making workshop to respond to the performance. Please note if you are interested in attending the workshops:
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