Wicomico County Health Department          Naloxone Online Registration Form
CONFIDENTIALITY:  Please note that none of your information will be shared

Trainings are now being offered virtually or in person.  After submitting the form, We will contact you to set up a day and time.


Opioid overdoses affect families, loved ones, and communities. Learn how to respond to an overdose by attending a virtual training and receiving your NARCAN kit for FREE.

Be a Hero, Save a Life.
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Be a good Samaritan-get Narcan trained so you can save a friend, neighbor, someone's family member, etc.
Would you prefer an in person or a virtual training? *
First Name *
Last Name *
Address (must be Wicomico County Resident) *
Phone Number *
Birthday (Month, Day, Year) *
Gender
Email Address *
Race / Ethnicity
Are you Hispanic or Latino?
Clear selection
Please check which category best describes your reason for attending and wanting/needing Narcan
Submit
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