Lincoln Center Moments: Schubert String Quintet, Presented in Collaboration with the New York Philharmonic on Friday, November 17th at 1:00pm
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.
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First name of participant with dementia:
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Last name of participant with dementia:
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First name of caregiver:
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Last name of caregiver:
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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):
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Please tell us about any accommodations that your group might need:
Is there anything else we should know regarding accommodations for your group?
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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 let us know which workshop you are most interested in attending following the performance:
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