REGISTRATION FORM

"PARTNERING WITH POISE"

A New ALEXANDER TECHNIQUE (AT) based course
FOR CARE PARTNERS OF PEOPLE LIVING WITH ALZHEIMER’S DISEASE
OR RELATED DEMENTIAS

PLEASE NOTE:

This course is now fully registered. However if you would like to be on the waitlist for future classes, you can go ahead and fill out the registration form, and when we have a new course for you to join, we will let you know.

PLEASE FILL OUT THE FORM TO JOIN A FUTURE CLASS…

Please note: This course is only for the family care partner, independent of their care receiver.

The course consists of a group class meeting for 90 minutes* once a week for 10 weeks.
NOTE: The first and last classes meet for two hours each.

It is understood that some participants may not be able to attend every class.

If you would like to view video interviews with some care partner participants who have taken this course before, you may go to:
Betty - https://vimeo.com/316280376*
Tom - https://vimeo.com/316280770
Marian - https://vimeo.com/370376914
Patrick - https://vimeo.com/394550062

QUESTIONS? Please contact the Executive Director of The Poise Project, Monika Gross
Email: monika.gross@thepoiseproject.org Phone or Text: 828-254-3102

Please fill out and Submit this form to be placed on a waitlist for future online Partnering with Poise courses. We look forward to seeing you in one of our clurses!

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am caring for

My spouse or partner

My parent

My child

My sibling

My aunt or uncle

Another relative

My friend

Any Questions or other message?

Workshop and Video and Images Waiver

I have read the Release and Waiver form above and am indicating my agreement with it by checking the box and by submitting this registration form.