Signup

Welcome!

We are so excited for you to join a Moving Together® class! Completing this form is the next step on the path.

Want to learn more about Moving Together? Visit our Program Information page.

Still have questions? Contact Us and let us know your situation and/or additional questions.

Please review before signing up for Moving Together classes:

Let's get started

After you submit this form, we'll call the primary participant's phone number and review class start dates, times, and next steps.

Primary contact email

Please enter a valid email address

This email belongs to

Someone else

Please select an option

Class Finder Questions

What is your relationship to the primary participant?

If you are signing up solo, choose "Self".

Self

As a class partner

As a care partner not attending class

As a family member not attending class

As a friend not attending class

As a case manager

Other

Please select your relationship

Primary Participant First Name

Please enter first name

Primary Participant Last Name

Please enter last name

Primary Participant Date of Birth

Primary Participant Preferred Phone Number

Please enter a valid phone number

I agree to receive text messages at the phone number provided above

Yes

Please select an option

Primary Participant Mailing Address

This is the location where the participant(s) will attend the online Moving Together class from the majority of the time. This is used to send them class supplies in the first weeks of class.

Note: Moving Together classes are currently offered to US residents only.

Street Address

Please enter street address

Address Line 2

City

Please enter city name

State

Please select a state

Zip Code

Please enter zip code

Country

Class Partner Information

Note: A family member, friend, or care partner is welcome to join the primary participant for classes as a Class Partner. A class partner is recommended for those attending the Seated or Active classes and optional for those attending the Balance and Coordination and Proactive Brain Health classes. There is no additional charge for a class partner to attend.

Class Partner First Name

Class Partner Last Name

Class Partner Relationship to Participant

Class Partner Email (If different than the primary contact email already provided)

Class Partner Primary Phone Number

I agree to receive text messages at the phone number provided above

Yes

Registration Complete!

Thank you for signing up for Moving Together® classes.

We will contact you soon to provide information on class start dates, times, and next steps.

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