Registration - Complementary Cancer Care

Welcome! Please create an account to register for our online Mind-Body or Creative Expression Classes.

You do not need to register to attend our Support Group Meetings.

First Name *

Last Name *

Username *

Phone Number *

City, State *

User Email *

Confirm Email *

User Password *

Confirm Password *

Yes! I would like to receive your Newsletters.

Yes
No, Thanks

My Medical Team is from (caregivers, please reply for your loved ones) *

Cancer Care Centers of Brevard
Health First Medical Group
Parrish Medical Center
Other

Notes

Medical Waiver for Mind-Body Classes *

I AGREE. I am signing that I have read and agree to the medical waiver below.

I understand that proper care shall be taken for my safety and well-being; I also understand that I am responsible for adjusting my practice to avoid injury. I assume all risk of damage or injury that may occur to me as a student by participating in the Mind-Body Classes. I release and discharge Complementary Cancer Care, Inc. and any of the Instructors from any claims, damages, demands, and actions of any nature that result from my participating in these classes.