Participant Questionnaire
"Every Voice Belongs" Workshop

Dear Caregiver/Guardian,Thank you for registering for Every Voice Belongs – Songs from the Heart of the Hill Country at Gem of the Hills, October 9–11 in Blanco, TX. Please complete the short questionnaire below.

First name*

Last name*

Age*

Guardian/Caregiver Name*

Guardian/Caregiver Cell Phone*

Guardian/Caregiver Email*

Emergency Contact (if different)

Participant creativity

If unable, no worries! Please let us know so we can plan.

Do you enjoy singing?

Yes

Writing?

Yes

Drawing?

Yes

Playing an instrument?

Yes

If so, what?

Favorite music?

Favorite movie?

Favorite color?

Favorite 2 songs?

Anything else you'd like us to know?

Medical & Safety

Food allergies/dietary restrictions

Serious medical conditions (seizres, asthma, etc.)

Sensory sensitivities (noise, light, etc.)

Permissions & Requirements

Will the guardian/caregiver remain on site?*

Yes

Snacks will be provided, but no meals.

No medication will be administered. (Volunteer retired nurses will be available courtesy of Gem of the Hills.)

I have read and agree to the terms in the liability waiver below.

I understand that completion of the questionnaire and agreement with the waiver are mandatory.

I give permission for photos, videos, and recordings to be taken, which may be used for promotional purposes.*

Yes

Waiver

By attending, I agree that I am acting independently, or if not, that I am attended to by a caregiver or guardian, and I further understand that Gem of the Hills, its employees and volunteers are not providing care during this workshop/concert. I agree that Gem of the Hills is not responsible in any manner for the workshop/concert or its content.

Gem of the Hills, Inc.

2233 US Highway 281 North
Blanco, Texas 78606

Mailing Address: PO Box 1572
Blanco, Texas 78606

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