Groove Fest Registration Form

Groove Fest Details:

Donty Horton Home Care Groove Fest Dinner &Dance Who: Individuals with Diverse Abilities + Caregiver; Provider Partners When: Saturday September 27th, 5:30pm – 10:00pm Dinner served at 5:30pm, Dance begins at 7:00pm Where: The Phillips Event Center 1364 Spring Lawn Avenue, Cincinnati, OH 45223
Participant Name

First NameLast Name
Phone Number
Email
example@example.com
Provider/Caregiver/Guardian Name & Phone Number
Will your caregiver stay at the event with you?

Yes, please add +1 to my registrationNo
Emergency Contact & Relationship
Emergency Contact Phone Number
Please enter a valid phone number.
Event Release & Disclaimer:

By attending this event, participants and their guardians and/or caregivers understand and accept that photographs and video may be taken for promotional purposes. Donty Horton Home Care is not responsible for any injuries or lost items during the event. Please be aware that flashing lights may be used at this event. Participation is voluntary and by registering you agree to enjoy, dance and have fun in a safe and respectful way!
Participant Signature

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Caregiver/Guardian Signature

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Groove Fest Details: