HeartBeats Group Development Form
Name:
Home Phone:
Email:
Work Phone:
Group Type:
Choose One
Interest
Knowledge
Life
Nurture
Group Name:
Number of Weeks:
Description:
(How you would like it to appear in the directory - subject to minor changes at time of proofing.)
Day of the Week:
Choose One
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Dates of the Group:
(Indicate any dates that will be skipped .)
Leader(s):
(Include the intern if you already have one.)
Phone Number(s):
(To be listed in the directory.)
Time of Group:
Begin Time:
End Time:
Meeting Place:
(Include address if not JCC.)
Number of People:
(Including leaders. Minimum of 3 and maximum of 12 unless approved.)
Open To:
(Be specific - if youth or children are involved, indicate by grades)
Childcare Available:
Choose One
No
Yes
Cost:**
**Please be specific about the cost. Include the cost of books, workbooks, and/or material and fees
associated with your group. The bookstore can check on the costs and availability. Money for materials
and fees FOR ALL GROUPS will be collected at JCC's bookstore.
Curriculum Request:
(Books or workbooks needed for your class)
Comments:
(List any extra comments or questions you have for the Heartbeats Directory about your class .)
By submitting this development form, you are agreeing to fulfill your responsibilities as stated in the
HeartBeats application packet.
When you click Submit this form will be emailed to the HeartBeats Coordinator.
Click here to report problems with this form
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