sINgSPIRE
Sanford Participant Information Form

sINgSPIRE is a 10-week individual voice lesson program that combats cystic fibrosis
through the art of singing.


Students are paired with a professional sINgSPIRE voice instructor based upon their age, weekly lesson availability, and instructor availability. Lesson materials, music, and program aides will be provided by Breathe Bravely.


Video-Call Lessons

An innovative and impactful teaching method for sINgSPIRE. Video lessons take place via a video call platform called ZOOM. Because of this technology, student and the instructor may remain in their respective locations and still take part in the program and lessons! The student must have access to reliable Wi-Fi and a device such as an iPad, tablet, or laptop. Instructions for connecting via video call will be sent out after enrollment into the sINgSPIRE program.


Please fill out the following form so we can best get to know you!

Sanford sINgSPIRE Student Information
Student Name *
Student Name
Next CF Clinic Appointment
Next CF Clinic Appointment
For purposes of scheduling to adhere to the study.
Mailing Address *
Mailing Address
Phone *
Phone
Communication Preference
What's the best way to get in touch?
sINgSPIRE Lessons
**** Lessons (30 minutes)
*Video-Call Lessons require a reliable Wifi connection & Video device.
Please give a general time frame so we may match you with an available sINgSPIRE instructor. (example: Monday 4:30 – 6:30 p.m. / Tuesday 7:00 - 8:00 p.m / Saturday mornings)
Previous Music Experience
Have you taken private music lessons before? *
Example: Piano - 3yrs
(general music, choir, band, theater, etc.)
Parent/ Guardian Information (if under 18)
Name
Name
Parent/ Guardian Phone
Parent/ Guardian Phone
Health & Emergency Contact
(cystic fibrosis, diabetes, asthma, anxiety, allergies etc.)
Emergency Contact *
Emergency Contact
Emergency Phone *
Emergency Phone
By typing your name in the box below you acknowledge that you are enrolling yourself or your child in sINgSPIRE - a program by Breathe Bravely specifically for people with cystic fibrosis and that all the information given is accurate.