JAMESTOWN RESPITE CLASS


(FOR CARE RECEIVERS OF JAMESTOWN CARE PARTNERS' CLASS PARTICIPANTS) 

Care Partner Class Participant - Please fill out this form in order for your care receiver (PlwPD) to be able to participate in any of the respite classes. Thank you!
Name of Care Partner Class Participant *
Name of Care Partner Class Participant
Name of Person Living with Parkinson's *
Name of Person Living with Parkinson's
Address *
Address
* PLEASE HAVE THE CARE RECEIVER ENTER THEIR NAME BELOW TO INDICATE THEY UNDERSTAND AND AGREE TO THIS WAIVER WITH THEIR NAME TYPED BELOW INDICATING THEIR AGREEMENT TO THIS RELEASE AND WAIVER.