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BK:00026 PG - 0872 <br />Triangle J Area Agency on Aging <br />Health Promotion Disease Prevention (HPDP) <br />EBHP Class Participation Report Form <br />County <br />Agency Name <br />Name of Person Completing Form: <br />CHECK ONE: <br />Date <br />Arthritis Foundation Exercise Program (AFEP) 0 Arthritis Foundation Aquatics Proaram Fl <br />Class started on <br />Number of sessions <br />and ended on <br />Number of total participants <br />Number who completed at least 80% of the sessions <br />Leader Name <br />Place /Location <br />Required documentation: Sign In Sheet <br />TJAAA Addendum Form July 2014 — June 2015 <br />