Jacksonville University Relaxation Program Information Form
Please complete form to sign up for a Relaxation Program training.
JU Student ID Number
Prefer to be Contacted By:
Arts & Sciences
Marine Science Institute
If so, what country are you from?
Are you a JU Athlete?
If so, what sport?
Are you a member of ROTC
Are you a Commuter Student?
As we look to tailor our training to you and get to know you better is there anything else you are comfortable in sharing that is meaningful to you (e.g., ethnic cultural background, religious affiliation, sexual orientation, physical ability/disability, etc.) Please list:
How did you hear about the JU Relaxation Program and Massage Chair?
Community Advisor/Residential Life
If referred by a particular faculty or staff member, who was it?
Are you coming to the Relaxation Room as part of a class assignment or extra credit?
If so, what class and professor?
Do you have any physical health problems?
If yes, please describe:
Which aspects of the Relaxation Program are you interested in:
What relaxation/stress management strategies do you currently use?
What days and times are you usually available?
Are you interested in joining a relaxation group or learning about additional trainings?
Should be Empty: