October 6 & 13 U-First! for Unpaid Care Partners Registration

Thank you for your interest in registering for the upcoming education session(s). We were hoping this would be in person, but unfortunately we must offer this via zoom at this time due to pandemic restrictions.

We will send you more information once you register!

Question Title

* 1. Please enter your contact information so we can contact you:

Name

City/Town

Email Address

Phone Number

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* 2. Please select which best describes you:

Unpaid Caregiver for someone living with dementia in a care home

Unpaid caregiver for someone living with dementia in the community

Paid Caregiver for someone living with dementia

A person living with Dementia

Other (please specify)

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* 3. Please describe your relationship to the person living with dementia

I care for my partner/spouse

I care for my mother/father/guardian

I care for a sibling

I care for a friend

I am a paid caregiver

Other (please specify)

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* 4. U-First! for Care Partners is designed as a 6 hour workshop. Are you able to attend all sessions as scheduled? These will not be recorded.

Yes, I plan on attending all sessions and understand they are not recorded

Other (please specify)

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* 5. If you are registering after Thursday, September 30, please reach out to the office directly to arrange getting materials mailed or picked up as this form may not be checked Friday/Monday.

Reach out to: Kim Parkinson: 613-544-3078 ext 201
reception@alzking.com
OR
Lisa Prest: 613-544-3078 ext 210
lprest@alzking.com

Yes I understand and will contact them

Other (please specify)

October 6 & 13 U-First! for Unpaid Care Partners Registration

Question Title

* 1. Please enter your contact information so we can contact you:

Question Title

* 2. Please select which best describes you:

Question Title

* 3. Please describe your relationship to the person living with dementia

Question Title

* 4. U-First! for Care Partners is designed as a 6 hour workshop. Are you able to attend all sessions as scheduled? These will not be recorded.

Question Title

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* 6. Are there any other questions or comments?