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Unified Work Mobile Academy | Brainerd RMCEP

Name: Unified Work Mobile Academy | Brainerd RMCEP
Start: 2022-12-06T10:00:00-06:00
End: 2022-12-06T14:30:00-06:00
Location: In-person

December 6, 2022

Time: 10:00 am - 2:30 pm

Location: Rural MN CEP, Inc. | Google Maps
204 Laurel St #21, Brainerd, MN 56401

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Participant Name*

First Last

Email Address*

Phone Number*

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T-Shirt Size*

Please list any needed accommodations that will help you be successful in the class:

Will you be bringing a support person?*

(If you feel you are unable to successfully and safely participate independently, please plan to bring a support person with you!)

Yes

Do you have any significant medical issues that the trainer should be aware of?*

Yes

Please describe:*

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Lunch Preferences

A sandwich or wrap will be provided. Would you like a vegetarian option?

Yes

If you have any food allergies or other dietary needs, please list them here. If we are unable to accommodate your requests, we will contact you prior to the class and suggest you bring a lunch with you.

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Date

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