Movement for the Mind: Participant Registration
Hi SLV Community!

We want to formally invite all school - aged individuals, 10 years and older, to participate in our FREE, 4-session Movement for the Mind project, which provides participants the opportunity to partake in various activities with the hope to provide a happy space to engage in physical activity. If you are registering more than one participant, please complete this form separately for each participant.

If you have any clarifying questions, please contact Dr. Colleen M. Schaffner, cschaffner@adams.edu or 719-580-2859
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First & last name of parent or legal guardian of the participant: *
Parent or legal guardian's phone number of the participant: *
Please use the following format, including your area code first: XXX-XXX-XXXX
Participant's name? *
Please provide the first & last name of the participant.
Participant's age? *
Contact Email Address *
Please provide us with the best email address to send you reminders and/or updated information about the Movement for the Mind events.
Emergency contact name: *
Emergency contact phone number: *
What is the relationship of the emergency contact to the participant? *
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