REGISTRATION FORM

"PARTNERING WITH POISE"

New!

An Alexander technique (AT) based course
For CARE PARTNERS
OF PEOPLE LIVING WITH ALZHEIMER’S DISEASE OR RELATED DEMENTIAS

PLEASE FILL OUT THE FORM TO JOIN THIS COURSE

Times: Wednesdays from 12:30pm-2:00pm
(First and Last classes meet until 2:30pm)

Dates: January 12 - March 16, 2022

Meeting Via Zoom

Participants: This course is open to care partners of people living with dementia who live in the United States

Cost: Free

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 register for the January 12 - March 16 Partnering with Poise course

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.