Registration Form Fall 2023 Thursday

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Use tab to navigate through the menu items.

Please check any that apply to you.

Headaches

Aching joints and/or muscles

Respiratory difficulties

Digestive difficulties

Rapid or skipped heartbeats

Nervousness or anxiety

Lack of concentration or focus

Depressed

Difficulty relaxing

Considering suicide

Feeling desperation or hopelessness

Grieving

Difficulties with anger

Fatigue or weariness

Difficulty sleeping

Current substance abuse

Extreme hearing loss

None of the Above

I have read and understand these risks.

Checking this box and adding my name and today's date below signifies that I agree with the above.

Thank you for submitting our Registration Form. We will get in touch with you soon.

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