King County Fall Prevention Program Locator

King County Fall Prevention Program Site Locator

Site Registration & Update Form
Thank you for keeping the King County Fall Prevention Program Site Locator website up-to-date! You can use this form to add, remove, or update a Delivery Site.

Please provide your contact information so we can follow up with you with any questions.
Your Name

First NameLast Name
Your Organization Name
Subtitle
Your Email
example@example.com
Your Phone
Please enter a valid phone number.Format: (000) 000-0000.
I need to:
The intention of the King County Fall Prevention Program Locator website is to connect community members who are looking for a program with sites in King County where they can either find a program now, get on a waiting list for the future, or just help to develop demand for these programs.

You are welcome to register sites that will offer one or more of the following Falls Prevention Programs in the next 12 months:
- A Matter of Balance
- Bingocize
- CAPABLE (Community Aging in Place, Better Living for Elders)
- EnhanceFitness
- The Otago Exercise Program
- SAIL (Stay Active and Independent for Life)
- Tai Chi for Arthritis & Fall Prevention
- Tai Ji Quan: Moving for Better Balance.
You do not need to have a confirmed schedule for the classes at this time.
What is the name of the site?
What is the site's address?

Street Address

Street Address Line 2

CityState

Zip CodeCountry
What is the site's phone number?
Site phone and website are optional. You can provide contact information (below) for a specific individual at the site instead or in addition.Format: (000) 000-0000.
What is the site's website?
Who should potential Falls Prevention Program participants contact at this site?

This information is optional. The information provided WILL BE POSTED TO A PUBLIC WEBSITE. Please only include contact information that you wish to be publicly available. If you do not wish to have staff members' names posted, you may use the title/role alone.
Name

First NameLast Name
Title or role at site
(e.g., "Program Coordinator")
Email
Example@email.com
Phone Number
Format: (000) 000-0000.
Which Falls Prevention Program(s) are available at this site? (Check all that apply.)
What is the name of the site you wish to remove from the Locator website?
To help identify the site, please provide its address:
Do you want this site removed immediately or on a certain date?
Date to remove site from the Locator:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Do you have any questions, or is there anything else we need to know?
Let us know what we can help with. If you need to update site information, please provide the information here.
Should be Empty:

King County Fall Prevention Program Site Locator

Who should potential Falls Prevention Program participants contact at this site?