Adult Classes Sign Up Form

Adult Classes Sign Up Form

Friendly and welcoming classes!
Our funders ask us to collect this information about everyone we work with. Please help us to keep these activities running. Rest assured that any information you provide will be kept confidential and your names or any identifying details will not be disclosed.

Some of our classes require a wellbeing form (that assesses self-improvement) that will be collected at the beginning and end of these courses.
Select which classes you want to sign up for:
Classes:*

"Chair Yoga" - Mondays - 11:30am to 12:30pm"Language Café (English)" - Mondays - 11:45am to 12:45pm"Lunchtime Yoga" - Mondays - 1pm to 2pm"Community Choir" - Mondays - 6pm to 7pm"Women Only Yoga" - Tuesdays - 9:15am to 10:15am"Health Hacks""Zumba for All" - Wednesdays - 1:30pm to 2:30pm
Name*

First NameLast Name
Gender*

MaleFemaleNon-BinaryPrefer Not to Say
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*

Confirmation Emailexample@example.com
Emergency Contact Name - This person will only be contacted in an emergency*

First NameLast Name
Emergency Contact Number*
Relationship to you*
Please tell us your age*

18-2526-3536-4546-5556-6566+
Ethnicity

White English / Welsh / Scottish / Northern Irish / BritishWhite IrishAny other White backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed / Multiple ethnic backgroundIndianPakistaniBangladeshiChineseAny other Asian backgroundAfricanArabicCaribbeanAny other Black / African / Caribbean backgroundAny other ethnic groupPrefer not to say
Have you ever attended a wellbeing class before?*

YesNo
DIFFICULTY/DISABILITY/HEALTH PROBLEM Do you consider yourself to have any long-term disability, health problem or any learning difficulties?*

YesNo
Employment Status*

Full-Time EmployedPart-Time EmployedPensionerNot Allowed To WorkUnemployed
Are you part of the LGBTQ+ community?*

YesNoPrefer Not to Say
Are you happy to be photographed for future promotion on Grand Junction's website and social media?*

YesNo
Do you want your email added to our mailing list?*

YesNo
Have you been to Grand Junction before?*

YesNo
Should be Empty:

Adult Classes Sign Up Form

Select which classes you want to sign up for: