Workshop Consent Forms

NCOA Consent Form

Statement of Consent

Please show us that you understand the information on the Participant Consent Form and how your survey information will be used. Check each box you agree to and sign below. Typing your name and today’s date will act as your digital signature.

Workshop Start Date(Required)

Workshop Type (Please Select from List)(Required)

Signature of Participant(Required)

First Name Last Name

Date(Required)

Signature of Guardian/Family Member/Legal Representative

First Name Last Name

Date

Relationship to Participant

Please provide the email address you used to register for the workshop(Required)

Signature(Required)

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Number

Georgia WIC

The Georgia WIC Program provides no-cost nutrition support for pregnant women, new mothers, infants, and children under age five. This includes monthly food benefits, breastfeeding support, nutrition… Read More

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