Act Now Foundation Caregiver Support Group
***Disclosure*** Act Now foundation intention is to protect personal information. We will not use this information beyond registration and immediate safety purposes.

Please note, Act Now Foundation will be using the platform-Zoom

In order to protect confidentiality during the group please read the following:

1. Please identify if anyone else can hear the conversation.
2. Remember that Zoom and the call host, may collect some basic information as to where calls originate, IP address, etc.
3. Calls will not be recorded. Please do not take screenshots, or take notes with personal information.
Name *
Address *
Email *
Phone Number *
Date of Birth *
Ethnic Breakdown *
Required
Race *
Required
Marital Status *
Required
Gender *
Required
Disabled?
Veteran?
Submit
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