ElderUp Activity Registration Form

ElderUp Activity Registration Form

Winter Session: Call if you have any questions or need help filling out this form (269) 312-3775
Available Classes

Chair YogaBoby BalanceCardio DrummingAfro-Cuban Gold: Chair Dance Fit
Arts & Create

Lap HarpFiber ArtsWatercolor Workshop
Readers Theater

Location: Hope Woods
Seasoned & Strong: All classes are held on Fridays @ 1PM -3PM . 3-week free program designed to support strength, heart health and overall well-being for older adults ages 55+. Each class is divided into 2 parts (Exercise & lively wellness conversation). Healthy snacks provided during class.

Skyrise Elderly Apartments: 105 E Walnut St. March 13-27
Your Name*

First NameLast Name
Birth Date*

MonthDayYear
Home Phone Number
Format: (000) 000-0000.
Mobile Number*
Format: (000) 000-0000.
Email Address*
example@example.com
Do you require wheelchair accessibility*
We do our best to be accessible to all abilities. Some locations may lack ramps or elevators. If you've marked yes to the question above, we will be sure to inform you of any challenges.
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any physical or dietary restrictions that may prevent you from participating in an ElderUp activity. Please note that ElderUp is a non-medical establishment led by volunteers to support social connection. Volunteers are not medically trained or allowed to treat or diagnose any condition. Consult your doctor before starting this or any other fitness class.

ElderUp Activity Registration Form

Emergency Contact Information