Your Name (required)

Email address (required) – you may enter more than one email address below – ie. Family members, staff or support.

2nd Email address (if necessary)

3rd Email address (if necessary)

What is your City/Town? (required)

What Province do you live in? (required)

What is your Postal Code? (required)

if you have a primary staff or support, what is their name and telephone number?

Who is your emergency contact? (required)

What is your birthdate?(required)

Phone (required)

Which Momentum Choir are you signing up for? (required)

Momentum Niagara (St. Catharines) Tuesdays from 3:30-4:30Momentum Hamilton – Mondays from 3:30-4:30Momentum Without Borders (our virtual choir) Thursdays, online from 3:30-4:30

Momentum Choir would like to post videos and photos of the choir and choir members on our social media pages, our website and the internet. Do you give Momentum Choir consent to do this? (required)

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Are you connected with an agency, group or association? Example – Community Living, Christian Horizons, Autism Ontario…
If so, please explain.

Is there any other information you’d like to share with us?

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