Exercise Class Attendance Form

Please take a moment if you have a SilverSneakers membership with the Whitney Senior Center. We will submit your attendance for reimbursement to help pay for the instructor's time. Thank you. If you do not have insurance, consider making a donation. Note Silver & Fit will only reimburse for in-person classes only.

If you have any questions, please feel free to give Paula a call at 320-255-7265.

We will send out a separate form at the end of August for you to fill out. If you do not want to fill out at this time we understand. Our goal and priority at Whitney Senior Center is to continue to bring you Wellness Programming and that you continue to attend as many of the sessions as you are able. If you have not filled out for previous months since March - please email Paula and she will email the link to the form to collect attendance to get reimbursed.

Reminder - if you have not filled out a Fitness Waiver and SilverSneakers agreement to participate in the classes, please go back to the newsletter to find the link to fill it out.

Name

First Name Last Name

E-mail

Phone Number

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please Note --If you do not have the SilverSneakers or Silver & Fit set up with the Whitney Senior Center and would like to go ahead and set up- please call our Front Desk M-F 8:00am to 4:30pm to provide your Birthdate and SilverSneakers number to set up by calling 320-255-7245.

Please Mark the dates you attended a Virtual Class to include Senior Yoga, SAIL, Pilates, and Tai Ji *

Please write any comments here.

Please use your cursor or fingertip on touchable screen to sign to confirm the above dates you selected. Whitney will submit appropriately to SilverSneakers or Silver & Fit.

Signature

Clear

Signature date