Activity Registration Form First Name * Last Name * Mailing Address Email Address Phone Number * Emergency Contact Name Relationship to you Phone Number (Please enter a valid Phone Number) Are you accompanied by a carer? Yes No Are you a financial member of Coolum HeARTs inc? Yes No Members: $5 - $10 Non Members: $10 - $20 Carers: $5 - $10 The carer fee entitles the carer to participate in the session as well as the client. How will you be paying per term? * Casual Full amount up front Which activities would you like to register for? (Please tick the relevant box and refer to the What's On Program for fees and direct debit information.) Art Monday 9:30 to 11:30 Choir Monday 10:30 to 12 Noon Meditation Wednesday Beginners 11:30 to 1:00 Ukulele Wednesday Beginners 11:30 to 1:00 / Intermediate 1:00 to 2:30 Men's Resilience Wednesday fortnightly with John Morning Mosaics Thursday 9:30 to Noon Gentle Yoga Friday 10:30 to 11:30 Heartbeats Djembe Drumming Friday 10:30 to 12 Noon Submit If you are human, leave this field blank.
