ElderUp Activity Registration Form

Available Classes

Chair YogaBoby BalanceCardio Drumming

Arts & Create

Lap HarpFiber ArtsWatercolor Workshop

Readers Theater

Location: KP Cinemas

Seasoned & Strong: All classes are held on Fridays @ 1PM -3PM . Select your location

Bethany Reformed Church Jan 9 - Jan 23Skyrise Elderly Apartments Feb 20 - March 3City View Apartments Senior Co-Op March 13- March 26

Your Name*

First NameLast Name

Birth Date*

MonthDayYear

Home Phone Number

Mobile Number*

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