Making Moves Registration Form
Please provide your contact information and personal preferences so that we can connect with you. Preference will be given to applicants within the service area of Great Expectations (Hamel, Long Lake, Medicine Lake, Medina, Minnetonka Beach, Orono, Plymouth and Wayzata).
*
Your answer
Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Birthdate (month, date and year) *
Your answer
Best Mailing Address (#, Street, City, State and Zip) *
Your answer
Best Way to Reach You *
What is your focus, day to day?
What would you like to learn more about?
What days and times work best for you to participate in the program?
Early Morning (ex. 7:30 - 9:00 am)
Midday (ex. 11:30 am - 1:00 pm)
Late Afternoon (ex. 3:30 - 5:00 pm)
Evening (ex. 6:30 - 8:00 pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Would you like transportation provided to/from sessions?
Would you like childcare provided during the sessions?
Please list any dietary restrictions.
Your answer
Why do you want to participate in the Making Moves pilot? *
Your answer
If you could describe this time in your life in one word, how would you describe it? I.e. confusing, exciting, scary, etc. *
Your answer
Do you feel as though you have access to the resources you need to live the life you want?
Your answer
By typing my full name below, I understand that I am applying to participate in the Making Moves pilot. *
Your answer
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