Facility Intake Form
We are excited to connect your residents and community members connected with talented musicians across the U.S.A. to bring them joy through music during social isolation. Our live stream Zoom sessions are moderated by a Dottie team member (a staff member at your facility can also be a moderator). There will be no video, audio, or chat option for your residents in order to respect their privacy. Your residents can access the performance with a link on a web connected device or by calling in (rates may apply for individual carrier). A member of our team will be in contact with you shortly after completing this form. Thank you!
Name of Facility/Community
Your answer
Your name
Your answer
Email
Your answer
Phone number
Your answer
How many residents/community members do you have?
What time would you like the performance? Select all that apply.
What date would you like the performance?
MM
/
DD
/
YYYY
Would you like more than one performance? If so please list dates below.
Your answer
Would you like the name of your facility/community shared with the performer?
Submit
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