Mindful Practices

Mindful Practices Registration (Virtual)

Mondays, Mar. 17 – Apr. 7, 5:30-6:30 p.m. PT with a retreat Saturday, Apr. 5, 9:00 a.m.-11:00 a.m. PT, 4-week series.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*
Are you a Providence employee?*

YesNo
Optional Demographic Information

Would you consider helping us continue to offer, improve, and enhance our free community classes and programs? This demographic information will help us improve our ability to serve our participants, enhance funding, and perform research around healthy lifestyle behaviors and our community-centered programming. All research data will be de-identified. We do not sell or give your information to third parties.
Would you mind answering our demographic questions?*

Happy to answer!No thanks.
Age
What race(s) do you consider yourself to be?

Alaska NativeAmerican IndianAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhite/CaucasianSome other racePrefer not to sayUnknown
What do you consider your ethnicity to be?
How do you identify?

ManNon-binaryWomanPrefer to self-describe
PARTICIPANT WAIVER

Please read the information below and then check the box indicating your understanding.
By checking the box below, you understand the following: I understand my name will be added to the Basecamp Prevention + Wellness contact list to receive information related to health and wellness. We do not share our database with outside groups.
Participant Waiver Acknowledgment*

I understand
If you have questions or comments regarding this registration or Mindful Practices, please send us an email.
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Mindful Practices Registration (Virtual)

PARTICIPANT WAIVER