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Exercise Class Registration Form

The Exercise program is held every Saturday at Art Fitness 2807 Concord Pike, Wilmington, DE 19803 from 8:30-9:30am. It is open to individuals with Down syndrome only, ages 13+”

This program is provided free to families by the Down Syndrome Association of Delaware.

Please complete the following registration form to reserve your spot in our Excercise classes.

Questions? Contact Jess at jess@dsadelaware.org.

Thank you!

Participant Contact Information

Participant Name

First Name

Last Name

Participant Email

Verify Email

Participant Phone

Participant Date of Birth

(mm/dd/yyyy)

This program is only open to individuals with Down syndrome. Does the participant have Down syndrome?

Yes

Are there any health or behavioral concerns for the participant that we need keep in mind?

Please provide the following information for TWO adult support contacts.

Adult Support Contact 1

Support Contact 1 Name

First Name

Last Name

Support Contact 1 Email

Verify Email

Support Contact 1 Phone

Type of Adult Support

Parent

Guardian

Other Support Person

Adult Support Contact 2

Support Contact 2 Name

First Name

Last Name

Support Contact 2 Email

Verify Email

Support Contact 2 Phone

Type of Adult Support

Parent

Guardian

Other Support Person

I understand by clicking SUBMIT I am registering for Exercise classes.

Yes, I understand.