Ready Steady – Registration

Are you concerned about falling?

Join others in your community to learn simple, effective exercises designed to improve balance and build strength.

Dates: 8 Wednesdays, May 7 – June 25
Time: 11am – 12pm
Location: Sabathani Senior Apartments Community Room
3701 3rd Avenue South, Minneapolis, MN 55409

Participant Details

First Name

Last Name

Phone

Language

Do you speak English well enough to receive services in English?

YesNo

What language do you prefer to communicate in?

Primary language spoken, if other

Demographics

The following demographic questions are optional and are to help us evaluate the reach of our programs.

Birthdate

Gender

Zip Code

What is your highest level of education?

Race/Ethnicity

African/Somali/Ethiopian	American Indian or Alaska Native
Asian	Black or African American
Caucasian	Hispanic/Latino
Middle Eastern or North African	Multiracial
Native Hawaiian or Pacific Islander	Other

Program Participation Questions

Please tell us a little more about why you are interested in this program and what you hope to get out of it.

Are there any dates you know you can't attend? Tell us more here.

Do you need any accommodations to be able to participate in this program?

Waiver

In consideration of my participation in this activity, I hereby release and discharge Sabathani Community Center, and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I may suffer as a result of my participation in this activity.

Initial that you have read and agree to the above waiver.

Your Rights Under GDPR