Movement for the Movement - Registration Form

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* 1. First Name

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* 2. Middle Name

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* 3. Last Name

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* 4. Address

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* 5. Email

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* 6. Cell Phone

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* 7. Have your practiced Capoeira before?

Who was your teacher/mestre? How many years have you studied?

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* 8. Do you have any physical injuries or disabilities that we should be aware of?

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* 9. Please list any dietary preferences. The Watershed will serve food that meets your preferences!

vegetarian

vegan

Pescatarian

Lactose-intolerant

Gluten-Free (celiac disease)

Gluten-Free (preference)

Sugar Free

Other (please specify)

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* 10. Please list any severe food allergies (i.e. you will go to anaphylactic shock if you ingest this food).

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* 11. Accessibility Requests: Please let us know if you have any access requests for us, so that we can make your stay as comfortable as possible.

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* 12. Limited partial scholarships are available for people who need financial support. Are you applying for financial aid?

Please briefly describe why you need financial aid, and why this gathering is important for you to attend.

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* 13. Will you need childcare during the gathering?

Please specify the number of children, their names & ages.

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* 14. How will you arrive at The Watershed Center?

If you are coming by Metro North. Please indicate if you will be taking the train that arrives in Wassaic at 4:03pm or 5:52pm for our free shuttle to The Watershed?

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* 15. How did you find out about this event?

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* 16. Please note, once your application has been reviewed you will receive a confirmation email with a link to complete payment. Your reservation will be complete once the payment is made. Please contact us at diasporaproductions@gmail.com or (551) 257-6788 with any questions.

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