Registration for Health Promotion Program Lakeshore
*
1.
What is your first name?
(Required.)
*
2.
What is your last name?
(Required.)
*
3.
What is your phone number?
(Required.)
*
4.
What is your email?
(Required.)
5.
What is your age?
*
6.
What is your fitness level?
(Required.)
Beginner
Intermediate
Advanced
7.
What would you like to get out of this class/workshop?
8.
How did you hear about this program?
9.
What would you like to see offered at LAMP?
Physical Activity
Relaxation
Health and Wellness
Social Activities
The Arts (Painting, dance, music, theatre, jewelery making)
Cooking
Other
10.
Would you like to volunteer?
*
11.
Name and phone number of Emergency Contact
(Required.)
