MOVING TOGETHER Sign up

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MOVING TOGETHER is a gentle, online, group movement program for people living with memory loss and their caregivers. Small groups of 7-10 people like you join classes from their homes using a computer, smart TV or other electronic device. During classes, you will be able to see and hear the instructor and other class participants, and they will be able to see and hear you.

Classes meet twice weekly for 12 weeks and we encourage but do not require participation with a partner. We will ask you some screening questions and make a recommendation as to which class is the best fit for you. Class participant numbers are limited so our instructors can give you personalized feedback. Classes are open on a space availability basis.

Note on privacy: We understand if you are reluctant to share information online. We are asking only what we need to make sure you are placed in the right class and we maintain strict company policies around data security and privacy. Nonetheless, if you would prefer to register by phone, please call (415) 237-3040. To contact us with questions, you can also email us at info@togetherseniorhealth.com

Email *

Participant with Memory Loss, name: *

Participant with Memory Loss, Email Contact: *

Participant with Memory Loss, Phone Contact: *

Person Filling Out this Form, Name (if different than Participant with Memory Loss):

Relationship to Participant with Memory Loss

Spouse or Partner

Daughter, Son or Other Family Caregiver

Friend

Paid Caregiver

Other

I am the Participant with Memory Loss

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Person Filling Out this Form, Email Contact (if different than Participant with Memory Loss):

Person Filling Out this Form, Phone Contact (if different than Participant with Memory Loss):

We recommend and encourage participation with a Care Partner in the same room. Will a Care Partner be available to participate with the Participant with Memory Loss? (Care partner can be a friend, spouse, care provider, family member.)

Yes

Sometimes

Other:

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