Guelph CHC Virtual Nutrition Workshop - Wed January 20 from 1:30-3:30 PM

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Only participants who complete this registration form will be allowed entry into nutrition workshops. Once you have completed the form you will receive a confirmation email with a Zoom meeting link and other class details. If you have any questions or concerns about this program please contact Shelley Murphy (smurphy@guelphchc.ca) or Abby Richter (arichter@guelphchc.ca).

Name *

Email address *

Phone Number *

Address *

List any dietary restrictions and/or allergies here:

Do you plan to: *

Mostly cook along

Cook along and watch equally

Cook a bit and watch mostly

Watch only

Required

Guelph CHC Priority Populations: Guelph CHC seeks to serve priority populations within the City of Guelph which includes individuals whose wellness is impacted by one or more of the following: homelessness, low income, mental health and addiction issues, LGBTQ+, vulnerable children, recent immigrant with language barriers, Indigenous peoples. Do you identify with one or more of these categories? *

Yes

Prefer not to answer

Online Privacy and Security Waiver: I consent to participate in this program, understand that there may be privacy and security limitations associated with 3rd party electronic solutions (registration process, virtual platforms, etc) and agree that the Guelph CHC is not liable for any associated privacy and confidentiality breaches. *

I understand and agree to the Online Privacy and Security Waiver

Personal Liability and Safety Waiver: Guelph CHC advises any program participant who has a health problem that might be negatively impacted by participating in this program to discuss their participation with their health care provider before beginning this program. In case of emergency our staff and volunteers are unable to respond as we would with an in person group. If you are concerned about your health and safety as it relates to taking part in this virtual program please ensure you have a support person or emergency contact nearby. By participating in the group you are indicating that you understand and agree that Guelph CHC will not be responsible for any injury, illness, safety concern or damage which may occur during your participation in the program *

I understand and agree to the Personal Liability and Safety Waiver

Is there anything you would like us to know about you to accommodate you better?

Submit

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