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If you need any assistance with registering, please contact Pam at 613-259-2182, ext. 2306 or Kara at 613-259-2182 ext. 2302What Program/Group are you registering for?(Required)Food Handler Certification CourseVirtual format progams use ZOOM (https://zoom.us/). Please complete this registration form and more details will be emailed to you regarding participation in our online programs. Please note, you must have high speed internet service with an internet connection – broadband wired or wireless (3G or 4G/LTE). Minimum bandwidth is 600kbps (up/down) and recommended is 1.5 Mbps (up/down). You can check your Internet bandwidth by going to https://www.speedtest.net/. You also need a microphone and webcam (camera built in or attached). If you do not have all three please do not register for online Programs. You can call ConnectWell Community Health for more information – 613-259-2182. If Virtual please confirm you have high speed internet service, a microphone and webcam.(Required) Yes No Name(Required) First Last Preferred Name (if different from above)Date of Birth DD slash MM slash YYYY Address(Required) Street Address Address Line 2 City Province Postal Code Telephone Number (Please provide only numbers where you permit us to call)Preferred(Required)Message Allowed(Required)YesNoAlternateMessage AllowedYesNoEmail(Required) Please provide only email that you permit us to use to contact you.This form has been completed by a third party for individual(s) without an e-mail address, please do not use the above e-mail address to contact them, use the provided telephone number(s).(Required) No Yes Emergency ContactName(Required) First Last Relationship(Required)Phone Number(Required)PrivacyAs a participant of this group, I will respect the privacy and confidentiality of other individuals in the group.(Required) Yes
