'Unforgettable Friends' Participant Interest Survey

'Unforgettable Friends' Participant Interest Form
Beginning Sept 25th, First Unitarian will offer a new program called 'Unforgettable Friends', a weekly activity program held at the church for people with mild to moderate cognitive decline including dementia and Alzheimers. If you or a congregant family member is interested in participating in the program or would like more information, please fill out the form below.
Name

First NameLast Name
Name of potential program participant

First NameLast Name
Email
example@example.com
Contact's Phone Number
Please enter a valid phone number.
Are you the caregiver?

yesno
Please let us know below any questions you may have. We will contact you shortly!
Should be Empty:

'Unforgettable Friends' Participant Interest Form