Language
English (US)
Spanish (Latin America)
Healthy Moves Interest Form
Thank you for your interest in Healthy Moves. Please complete the form below. Upon completion of the form you will be added to our list ; once dates are made available for cohorts; we will reach out. If you have any questions or concerns please feel free to reach out to aiturbe@gadshillcenter.org
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
Preferred mode of communication
Email
Cellphone
Text
Site
Please Select
Cullerton
Ogden
Brighton Park
Chicago Lawn
Other
If other; please explain
School Name, Community Fair, or Chosen Neighborhood
Preferred Language
English
Spanish
Other
Preferred Lesson Time
Morning ( 9:30 - 11 :30 AM)
Afternoon ( 2:00 - 4:00 PM)
Evening ( 5:00 - 7:00 PM)
Preferred days of the week
Monday
Tuesday
Wednesday
Thursday
Friday
How did you learn about Healthy Moves
Referral
Flyer
Health Promoter
Social Media
Attended Information Session
Attended a Healthy Moves Charla
Other
Submit
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