DWP IN-PERSON: PRINCE EDWARD ISLAND

FREE IN-PERSON DANCE CLASS FOR THOSE LIVING WITH PD

LOCATION: Central Christian Church, 223 Kent Street, Charlottetown
WHEN: Thursdays, 1:00pm - 2:00pm AST

ALL CLASSES

This class is for people living with Parkinson's disease. It will begin seated, move to stand behind the chair, and finish with the option of moving through the dance space. All abilities are invited to participate, and the dances can be modified for safe enjoyment. Wheelchairs and walkers are welcome. Care partners are welcome to join in but not necessary. We have lots of volunteers to help.

DWP IN-PERSON: PEI

Name

First Name

Last Name

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is your age range?

What is your gender?

What is your first language?

If you indicated "Other" above, please indicate first language below

How did you hear about our classes?

Choose from one of the options below:

Place of Residence

Emergency Contact 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.)

DWP IN-PERSON: PRINCE EDWARD ISLAND

START DATE: JANUARY 4, 2023