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REGISTRATION FORM

"PARTNERING WITH POISE: Caring for the Care Partner”

**FREE ONLINE GROUP COURSE**

led by Nina Reed of Winterville NC
a trained peer care partner leader
Tuesdays from March 4 - May 20, 2025
6pm to 8pm ET via Zoom

Are you a person of color who is a spouse, parent, child, grandchild or friend
of someone living with dementia or other cognitive challenges?

This free online course supports your personal well-being and safety
independent of the person you are caring for.

You will have fun in an enjoyable social setting AND you will take away practical strategies
that will support you physically and emotionally today
and for the rest of your life.

We invite you to learn and support one another
in this new affinity group for people of color
who are CARE PARTNERS of people living with dementia or cognitive decline

Funded by a grant from the Alzheimer's Foundation of America.

“Partnering with Poise: Caring for the Care Partner” is an evidence-based program developed by The Poise Project with funding from the Parkinson's Foundation. It was researched through the University of Idaho.

Our workshop approach is adapted from Alexander technique, a well known performing arts training
to help manage stressful situations, and prevent, or recover from, strain, pain or injury.

Our research can be viewed at this link: www.thepoiseproject.org/tpp-research

This group class meets via Zoom for 2 hours on Tuesday evenings for 12 weeks from March 4 - May 20 2025.

We will support and encourage you to take these few hours each week for yourself.
We believe that your needs and your health matter just as much as the person you care for.

Of course it is understood that some participants may not be able to attend every class.
That is fine! Things happen!

If you can’t attend a class, or if you can only attend part of a class,
each class will be recorded so you can view it in your own time.
In this way, you can participate in the activities on your own before the next class meets and stay connected.

We also understand if during class you may need to take time to help your care receiver.
That’s one of the big reasons why our online in-your-home courses have been making it possible for care partners to participate more regularly, and with more flexibility.
We understand - we get it - because we were care partners for someone living with dementia, too.

If you would like to see some video interviews with care partner participants
from an earlier series of in person classes in North Carolina funded by the Parkinson’s Foundation
please go to these links:
Eunice - https://vimeo.com/394548815
Betty - https://vimeo.com/316280376
Tom - https://vimeo.com/316280770
Marian - https://vimeo.com/370376914
Patrick - https://vimeo.com/394550062

QUESTIONS?

Nina Reed, Course Instructor
Email: ninareed76@gmail.com
Phone or Text: 917-215-4581

Please share this information with others in your local community, or anywhere in the US!
You can download a flyer by clicking here.

Please fill out and Submit this Registration Form & Waiver. Someone will contact you soon then to confirm your participation.

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?

RELEASE AND WAIVER I do hereby release, waive and discharge The Poise Project ("The Poise Project") and their affiliates, trustees, directors, officers, employees, volunteers, assistants and agents (“Releasees”) from any and all liability for injury, loss, damage, obligation, expense or penalty, including attorneys’ fees, that I may cause or sustain in connection with my participation in The Poise Project's one-to-one instruction, group classes, workshops, programs or events whether caused by the negligence or carelessness of Releasees or otherwise. I understand that Releasees do not have medical personnel available at their one-to-one instruction, group classes, workshops, programs or events, and I agree that Releasees assume no responsibility for any injury or damage that might arise out of or in connection with my participation with any of The Poise Project's activities. By signing below, I knowingly and voluntarily assume all such risks, and assume sole responsibility for any accident or injury to myself and other persons or property arising out of or in connection with participation in The Poise Project's one-to-one instruction, group classes, workshops, programs or events. In addition, I have adequate coverage under a health and accident insurance policy applicable to the activities in which I may engage. I further agree that any images or videos taken of me during any of The Poise Project's one-to-one instruction, group classes, workshops, programs or events may be used by The Poise Project for archival documentation or publicity purposes. By agreeing to this Release and Waiver by indicating such in the check box below, I represent that I have read its contents, that I understand it and that I agree to it voluntarily as my own free act and deed. I further state that I am at least eighteen (18) years of age, am fully competent to sign this document and that I execute this Release in consideration of my participation in The Poise Project's activities and programs, fully intending to be bound by same. By submitting this form, I indicate my agreement to this Release and Waiver.

* PLEASE WRITE YOUR NAME BELOW TO INDICATE YOUR SIGNATURE AGREEMENT TO THIS RELEASE AND WAIVER.