Registration for Health Promotion Program Lakeshore

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your phone number?

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* 4. What is your email?

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* 5. What is your age?

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* 6. What is your fitness level?

Beginner

Intermediate

Advanced

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* 7. What would you like to get out of this class/workshop?

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* 8. How did you hear about this program?

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* 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

Registration for Health Promotion Program Lakeshore

Question Title

* 1. What is your first name?

Question Title

* 2. What is your last name?

Question Title

* 3. What is your phone number?

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* 4. What is your email?

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* 5. What is your age?

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* 6. What is your fitness level?

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* 7. What would you like to get out of this class/workshop?

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* 8. How did you hear about this program?

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* 9. What would you like to see offered at LAMP?

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* 10. Would you like to volunteer?

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* 11. Name and phone number of Emergency Contact