STANDING CLASS THURSDAYS AT 4:00 PM ESTVIA ZOOM 45 MINUTESFREE ALL CLASSES This class is intended for those living with Parkinson's disease who are able to stand without support, and feel safe moving independently for a 45-minute period. Care partners are welcome, but not required. Register Standing Class Registration Name * First Name Last Name Email * Phone Number * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country What is your age range? * Under 20 years old 21 - 30 years old 31 - 40 years old 41 - 50 years old 51 - 60 years old 61 - 70 years old 71 - 80 years old 81 - 90 years old 91+ years old Prefer not to say What is your gender? * Female Male Other Prefer not to say What is your first language? * English French German Italian Spanish Portuguese Arabic Mandarin Cantonese Punjabi Hindi Hindi Other (please indicate below) If you indicated "Other" above, please indicate first language below How did you hear about our classes? * Parkinson Canada Parkinson’s support group Media DWP website Care partner Seniors Residence/Facility Friend/Family Community Organization Neurologist General Practitioner/Nurse Other Choose from one of the options below: * I am a person living with Parkinson's disease I am a senior (55+) I am a care partner Other Place of Residence * I am a senior living in a retirement home I am a senior living in a long-term care facility I am a senior living in my own home I am a senior living with a family member in their home I am a care partner I am a recreation manager at a LTC home Other Emergency Contact * First Name Last Name Emergency Contact Phone Number * (###) ### #### WAIVER & ACKNOWLEDGEMENT * I acknowledge that Dancing with Parkinson's is not responsible for any injury sustained during the course of a dance class. I assume all risks and liability for any injury resulting from engaging in any classes in person or online. I agree that by completing this form I understand that I give Dancing with Parkinson's permission to email me about DWP classes and events. (Note: You may unsubscribe at any time, however we advise that you remain on our list for important notifications.) YOU ARE REGISTERED! Here is your Zoom link: https://us02web.zoom.us/j/85114575326 Save this Zoom link! Copy and paste the above link to save it on your desktop, in your notes, or in a folder for easy access every time you want to attend the Standing Class. Is this your first time joining this class? You will receive a confirmation email with all the information you will need prior to attending. We look forward to dancing with you!
