First Name

Last Name

Phone *

Email *

Postal Code

What is the age of the loved one you support?

Would you like information about our Adult Day Training program?

Yes, please contact me.

No, I'm attending for caregiver support.

I'm not sure yet.

Does your loved one currently receive APD Waiver services?

I consent to receive non-marketing text messages from Rest Assured Home Care, LLC d/b/a SureCare Connections about my Caregiver Connection Circle registration, event confirmations, reminders, scheduling updates, and responses to my inquiries. Message frequency may vary. Message & data rates may apply. Text HELP for assistance; reply STOP to opt out.

I consent to receive marketing text messages from Rest Assured Home Care, LLC d/b/a SureCare Connections about caregiver resources, programs, services, events, and special offers. Message frequency may vary. Message & data rates may apply. Text HELP for assistance; reply STOP to opt out.