Wufoo

Exercise Connection Registration

Looking for an exercise partner to share your enjoyment of hiking, biking or walking? Let the Bikkur Cholim / Health and Healing Committee know, and we’ll give you a list of other interested Temple members. Choose to exercise with someone who lives close by or join a group. The choice is yours!

Exercise Connection is a response to requests for more exercise programs on the recent Health and Wellness Needs & Interests Survey. This matching service is sponsored by the Bikkur Cholim / Health and Healing Committee chaired by Diane Burr.

Make an Exercise Connection for pleasure and health!

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Your address is required, and will help us find you an exercise companion near your home or business.
Phone ### - ### - ####
If you provide us with your phone number, we'll only contact you during your "Best Time to Call." If you choose not to provide your phone number, please provide an email address so we can contact you.
Best Time to Call
Morning Afternoon Evening
Email

Please make sure you've entered your email address correctly. If you choose not to provide your email address, please provide a phone number so we can contact you with potential exercise partners.
What type of exercise are you interested in?
Walking Hiking Biking
Please rate your exertion level during exercise.
Easy Moderate Strenuous
How often would you like to exercise?
Daily 2-3 Days per Week Weekends Weekly
When would you like to exercise?
Morning Afternoon Evening
Where would you like to meet for exercise?
Near My Address PJTC?
Do Not Fill This Out
Do Not Fill This Out