LTC Transitional Registration
  • LTC Transitional Self-Health Group

    Please add your contact information below if you are interested in participating in our 8 week Series. Dates will be announced based on Registrant numbers. This is a closed group.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Registration

  • Select the session you are registering for:*
  • My loved one is currently living:*
  • I would benefit from respite care while I attend these education sessions. Please call me to discuss my options. Please note we need 2 weeks notice prior to the session start date to setup respite care.
  • Disclaimer

    This information will be used for statistical purposes and will be stored on our electronic database; it will be kept confidential and will not be shared outside of our organization. I freely consent to participate in the offered program that will be led by an Alzheimer Society staff member or volunteer. I acknowledge that it is my choice to participate in this activity and I understand that I am free to withdraw from, reduce or modify my involvement in any part of this activity. For programs where food is served, I understand that the organization can only serve store bought, pre-packaged foods, and cannot guarantee an allergen-free environment. I understand the Alzheimer Society of Niagara Region has taken reasonable safety precautions, including following Ontario Public Health recommendations, as a response to Covid-19. I agree to indemnify and hold the Alzheimer Society of Niagara Region harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement. In the event that a program session must be cancelled due to unforeseen circumstances, we will attempt to contact you if given permission above. Participants are encouraged to phone the Alzheimer Society of Niagara Region regarding program changes.

  • Accept disclaimer*
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