Registration Form

Note: Items marked with * are required. Other items are optional, but you are encouraged to fill out all sections as completely as possible to assist me in customizing your program.

Part A
Name *
Name
Primary phone (mobile number if you have one) *
Primary phone (mobile number if you have one)
If you have a non-US phone number that does not fit in these blocks, please type it in the block in Part H.
Other phone
Other phone
Birthdate *
Birthdate
Home Address
Home Address
Someone to call in case of emergency *
Someone to call in case of emergency
This person's phone number *
This person's phone number
If your emergency contact person has a non-US phone number that does not fit in the blocks, please type it into the block in Part H.
Part B
How did you hear about me?
Part C
Which component(s) of my program are you are interested in? (Check all that apply.) *
Part D
If you are not a singer, please skip this section and go to Part E.
e.g. Soprano, Belter, Bass-Baritone, Rock Tenor
Style(s) of singing you do
Check all that apply
Include anything from singing in the shower to church choir to professional engagements.
Your response may include singing issues (expand range, learn to sing quietly in high range, fix wobble), performance issues (stage fright, shallow breathing), and physical issues (jaw tension, back pain, nodes).
Part E
Even if you're enrolling only for voice lessons, you are asked to complete this section because any aspect of your health can potentially affect your voice.
Health Status/History

Current symptoms *
Are you currently experiencing any of the following symptoms? (Check all that apply.)
Are your symptoms
Check the appropriate box(es) to indicate which healthcare professionals, if any, you've consulted about this condition:
Indicate your daily caffeine consumption:
(coffee, tea, soda, etc.)
When do you drink the caffeinated beverages?
(check all that apply)
Indicate your current tobacco use:
Indicate your current alcohol consumption:
Are you happy at your current weight/fitness level?
Are you satisfied with your current diet?
Indicate your fitness level
How often do you exercise?
Indicate the stress level of your life:
Do you feel physically good most of the time?
Do you feel happy/content most of the time?
Part F
What type of introductory visit would you like? *
I will do my best to find a slot that suits you. I teach M-F and offer morning, afternoon, and evening appointments.
Part G
Allergies *
In order that I can ensure your comfort while you are in my studio, please check the appropriate box(es) to let me know if you have sensitivities to these potential allergens:
Part H
Sign to confirm your intention to enroll. (If you are under the age of 18, please have a parent or guardian sign for you.)
You must arrive on time for appointments and may be required to pay the full fee for any appointment shortened by your late arrival.

You must give at least 6 hours' notice to cancel an appointment. Unless there are extenuating circumstances (to be determined by Michael), you may be required to pay in full for any appointment cancelled without sufficient notice.

Each session must be paid for in full no later than at the time of your appointment by cash, check, or credit/debit card. (Online payment is also an option.) If your check is returned unpaid by your bank, Michael will assess a $15 processing fee and may require different means of payment in the future.

The bodywork component of Michael's program may assist your body in its self-healing process, but it is intended to complement medical care, not substitute for it. Some conditions may require intervention from a medical doctor or other health professional. You must inform Michael of any relevant changes in your medical status, including episodes of pain or discomfort, that arise while enrolled in his program.