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Cognitive Skills Workshops
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Email
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Participant Name
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Birthday: Month/Day/Year
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Contact Email for Participant:
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Phone # for Participant:
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Home address
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Do you have any physical limitations that the instructor should know about? (Please specify below.)
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I am a guardian/loved one filling out this form. My contact information (email and phone number) is:
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Any additional information you'd like the instructor to know?
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How did you hear about this program?
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I am aware that this is not treatment for any specific mental health disorder, but an educational workshop for adults.
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