Community Camps, Inc.

Medication
Administration
Online Registration

* = Required

Name*:

Agency:

Address*:

City*: State*: Zip*:

Phone*:

Fax:

Email*:

Select Course Location/Date*
Med
Admin
Epi
Only
West Hartford - 6/4/19
West Hartford - 6/5/19
Groton - 6/6/19
Torrington - 6/14/19
Enfield - 6/15/19
Fairfield - 6/17/19
Bloomfield - 6/18/19
Hartford - 7/1/19
Other - Date:

Additional registrants from the same agency:

Fees:
Medication Admin. (incl. epi-pen) - $45/person
Epi-Pen Only - $30/person

Total Payment Due: $

Payment Options
Credit Card - securely via PayPal (on the next screen)
Purchase Order - P.O. Number:
Invoice Me
I will bring a check to the class - payable to "Community Camps Inc"

 

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