Community Center Senior Program Registration

Community Center Senior Program Registration — Form Fields

This registration template includes 10 fields. Register seniors for activity programs at the local community center. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, optional)
• Phone Number (text, required)
• Age (number, required)
• Emergency Contact Name (text, required)
• Emergency Contact Phone (text, required)
• Programs of interest (checkboxes, required) — options: Chair Yoga, Water Aerobics, Bridge Card Club, Book Club, Computer Basics, Art & Crafts, Line Dancing, Movie Afternoons
• Do you have any mobility limitations? (multiple choice, required) — options: No limitations, Use a cane, Use a walker, Use a wheelchair
• Medical conditions relevant to physical activities (long text, optional)
• Do you need transportation assistance? (multiple choice, required) — options: Yes, No