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Registration Form: Fall Experiences
Use this form to register for our fall class offering. Please check out our website for class descriptions and pricing. www.dignityworkshere.org
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Email
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Your email
Your Name - person completing the form.
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Your answer
Best contact phone number
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Your answer
Participant's name
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Your answer
Is the participant 18+? Currently, Dignity Works Here, Inc. programming is for participants 18 years and older
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Yes
No
Has the participant been enrolled in any other Dignity Works Here, Inc. programming (Project ELEVATE or Summer Workshop Series at Bethany)
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Yes
No
Would you like to register for
Dance Works!
Tuesdays from 4-5pm D
'Antono Dance Studio - Pine Island, NY
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Yes
No
Would you like to register for
Animal Art and Basic Photography
Tuesdays from 6-7:30 pm Bethany Retreat Center, Highland Mills, NY.
Please note: a cell phone or tablet is required for this class.
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Yes
No
Would you like to register for
Fitness Ninja!
Thursdays from 4:15-5:15 pm Bethany Retreat Center, Highland Mills, NY
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Yes
No
Would you like to register for
Hola! Intro. to Spanish
. Thursdays from 5:30-6:30 pm Bethany Retreat Center, Highland Mills, NY.
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Yes
No
Do you have Self Direction?
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Yes
No
If you have Self Direction - who is your FI(fiscal intermediary)? Write none if you don't have self direction.
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Your answer
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