MOVEMENT FOR WELLNESS: PARKINSON'S + MOBILITY FRIENDLY
Class Registration Form
Name
First Name
Last Name
Email
example@example.com
ZIP CODE
CONTACT NUMBER (optional)
-
Area Code
Phone Number
I AM:
a returning/continuing dancer from a previous session
a new dancer to the program / this is my first session with HSDC
I AM MOST INTEREST IN (select all that apply):
Parkinson's Project - creative movement classes for individuals and caretakers managing the diagnosis of Parkinson's.
Mobility Friendly - a variety of class options designed for every-BODY (abilities, ages, experiences)
Retiree Enrichment - offers creative movement and dance education classes through unique partnerships like Osher Lifelong Learning Institute, OLLI at NW
THANK YOU! YOUR REGISTRATION IS ON FILE
Questions? Please contact: education@hubbardstreetdance.com
OPTIONAL SURVEY BELOW:
YOUR RESPONSES WILL CONTRIBUTE TO THE PLANNING OF OUR FUTURE SESSIONS
I PREFER TO ATTEND CLASS (please select ALL that best apply):
Virtually (live, via zoom)
In Person (at the HSDC Studio: Water Tower Place 4th Floor)
In Person (at a neighborhood/nearby community location)
Hybrid (I am open to both forms of classes)
On-line, Pre-recorded (videos posted to the HSDC webpage & accessible at any time)
THE BEST TIME(S) OF THE DAY FOR ME TO TAKE CLASS:
Mornings between 9am - 11am
Afternoon between 12pm - 2pm
Mid-day between 3pm - 5pm
Evenings between 5:30pm - 7pm
Other
Submit
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