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Courage for Caregivers
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Cell Phone Number
*
Your answer
Home Phone Number
*
Your answer
I am
*
1. Clergy/Pastoral Care Provider
2. Caregiver to a Loved one (If here, please answer next question)
3. I Want to Learn More About Caregiving
I am Caring for ....
*
Child
Parent
Friend/Loved One
My Home Church/Parish is...
Your answer
Preferred Method of Communication
*
Email
Phone
Text
Homing Pigeon
Smoke Signals
Preferred Payment
*
Credit Card
Cash
Cheque (Please make cheque payable to St. Aidan's Anglican Church)
Food Allergies
Your answer
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