Wicomico County Health Department Naloxone Online Registration Form
DATE: 2nd Tuesday of Month from 6:00 pm - 7:00 pm
4th Monday of Month from 12:00 pm - 1:00 pm

LOCATION: Online Virtual Session

CONFIDENTIALITY: Please note that none of your information will be shared

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.
Sign in to Google to save your progress. Learn more
Be a good Samaritan-get Narcan trained so you can save a friend, neighbor, someone's family member, etc.
Which Virtual Naloxone Training are you Registering for? *
First Name *
Last Name *
Address (must be Wicomico County Resident) *
Phone Number *
Birthday (Month, Day, Year) *
Email Address *
Race / Ethnicity
Other: Please check which category best describes your reason for attending and wanting/needing Narcan *
Clear form
Never submit passwords through Google Forms.
This form was created inside of State of Maryland. Report Abuse