Registration Form: Care Partner Support Series

After you submit your payment for the Nithview or Spruce Lodge Care Partner Support Series, please complete your registration by filling in this form.

    Registration for: Nithview New HamburgSpruce Lodge Stratford

    FemaleMale

    *I am paid for my caregiving role: YesNo

    *I am caring for a person with dementia YesNo

    Types of dementia (if known):

    *I am caring for:

    *I am caring for: