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 *First Name: *Last Name: *Email: *Phone: *Address: *City: *Province: *Postal Code: FemaleMale *What is/was your occupation? *How many years have you been a caregiver? *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: select onefemales onlymales onlyboth females & males *I am caring for: select onemy spousemy in-lawmy significant othermy siblingmy parent or step parentfriend/neighborother Your Message Yes, I would like to receive announcements from WithCare Training
