Sunday Wellness Sign-Up Form
Take an hour for your health every Sunday! Join us for a fun and relaxing combination of 30 minutes of Tai Chi followed by 30 minutes of Zumba. All ages and fitness levels are welcome!📅 Every Sunday🕓 4:00 – 5:00 PM📍 During hot weather: Inside the Spokane Valley Library22 N Herald Rd, Spokane Valley, WAWhen the weather cools: Balfour Park (Liberty Tree) Suggested Donation: $5 per class Proceeds benefit Nourish Spokane Soup Kitchen & Food PantryMove • Connect • Give BackBring a friend and let's build a healthier, stronger community—one Sunday at a time!
Participant Information
First Name
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Last Name
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Date of Birth
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Month
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Day
Year
Date
Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
City
Emergency Contact
Emergency Contact Name
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First Name
Middle Name
Last Name
Emergency Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Participant
Program Selection
Which activity are you interested in?
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Tai Chi
Zumba
Both Tai Chi and Zumba
Are you a returning participant?
Yes
No
Health & Safety
Do you have any medical conditions or physical limitations we should be aware of?
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Yes
No
If yes, please explain
In case of emergency, I authorize program staff to seek medical attention on my behalf if I cannot be reached.
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Yes
No
Signature
Electronic Signature
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Date
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Month
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Day
Year
Date
Submit Registration
Submit Registration
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