Chatting to Wellness Online (Phone Call) Chatting Sessions Registration
This form is for someone to sign up another person for an Online Chatting Session (son/daughter registering mother/father, etc.)

Please complete all forms to register for Online Chatting Sessions. The first section is for you, the person registering for a senior, and the second section is information about the senior.
Your Name *
Your Address *
Your Email *
Your Phone Number *
Seniors Name *
Senior's Age *
Senior's Address *
Senior's Email
Senior's Phone Number *
What day(s) are you available for a call? (Calls are between 6pm-9pm) *
I agree to the terms and conditions of Online Chatting Sessions and for communications (Found here: *
[OPTIONAL] Additional Comments (language, hard of hearing, extension number, etc.)
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