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Adult Exercise & Wellness Program
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* Indicates required question
Email
*
Your email
Full Name (First and Last
*
Your answer
Phone Number
*
Your answer
Communication preference
*
text
email
phone call
Required
Preferred class of interest (select all that apply)
*
Line Dance
Chair exercises
Zumba
Other
Required
Preferred Day of the Week (select all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Required
Preferred time of day. (select all that apply) You can specify specific times in the Other line.
*
Morning (between 9:00am and 12 noon)
Evening (between 5:00 pm and 7:00 pm)
Afternoon (between 1:00pm and 4:00 pm)
Other:
Required
Goals (select all that apply)
*
Improve balance/fall prevention
Increase strength
Manage weight
Social interaction
General fitness
Other:
Required
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