Thank you for your interest in Unstoppable Adults! Please fill out the information below to join our program and take a step toward greater independence and vocational training.
For questions or to submit this form, please contact us at chantel@bhhands.com or 773-349-1994.
Areas of Interest (Check all that apply):
Emergency Contact Information
Full Name: ________________________________________
Relationship to Participant: ___________________________
Phone Number: ___________________________________
Additional Notes or Special Accommodations:
Signature: ___________________________
Date: _______________
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