Keys to Healthy Living Zoom Registration

1. First name

Last name

2. Email

3. Phone

4. Do you have a physical condition or limitation that may affect your participation in chair exercise?

No

Yes

If Yes, please explain.

5. This Two-Day Zoom series includes prayer, nutrition tips, stress management, chair exercise, a Mother's personal story of hope following tragic loss of son. Knowing this, do you wish to participate?

Yes

No

6. Please select the session(s) you plan to attend. (Each session includes different wellness topics and a chair exercise session. You are welcome to attend one session or both.)

Thursday, September 17, 2026 (One-Day Registration – $10)

Saturday, September 19, 2026 (One-Day Registration – $10

Both Sessions – September 17 & 19 (Two-Day Registration – $17)

Referral for a Scholarship registration.

7. What do you currently do to support your mental wellness?

8. Registration Donation Payment-( Tax-deductible Donation Registration Fee supporting MAB Wellness Outreach's Youth Mental Wellness Program during Suicide Prevention Month. Thank you for helping us inspire hope, promote wellness, and transform lives.)

9a. Complete Your PayPal Registration Payment

One-Day Registration ($10)-https://www.paypal.com/ncp/payment/Q8HV5Q6B5BLZW

9 b. Complete Your PayPal Registration Payment

Two-Day Registration ($17)-https://www.paypal.com/ncp/payment/S4VVFQ2Q3Z26N

10. This Zoom session may be recorded for educational, promotional, grant reporting, website, YouTube, social media, and future MAB Wellness Outreach educational purposes:

YES I give permission for my image, voice, and comments to be used.

NO- I do not wish to appear in recordings. ( If NO, we recommend keeping your camera off and changing your display name if desired.

Liability Acknowledgement-

I understand that participation in this Zoom wellness series and chair exercise is voluntary. I certify that I will participate within my own abilities. I understand MAB Wellness Outreach provides educational information only and does not provide medical or mental health treatment. I release MAB Wellness Outreach, its staff, volunteers, sponsors, and partners from liability for injuries related to my participation, except where prohibited by law. I have read and agree.☐