CB Moves Interest Form
We are excited to welcome you/your student! Registration for Youth and Adult classes begins in August for classes starting late September. Parkinson's classes are ongoing throughout the year on Mondays, Wednesdays, and Fridays at 2pm. Please fill out this form to indicate your interest, and we will contact you regarding pertinent programming.
Name
*
First Name
Last Name
Best Phone Number to Contact
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best Email Address to Contact
*
example@example.com
I am filling out this form on behalf of:
*
myself
my child
my spouse/partner
my parent
Other
Participant Name
First Name
Last Name
Please contact me regarding classes for:
*
Youth (ages 4-18) with disabilities
Adults (ages 18+) with disabilities
Seniors
Persons with Parkinson's and carepartners
Individuals with Dementia or other memory concerns and carepartners
Other
Submit
Should be Empty: