REACH Registration Form

REACH Registration Form

Thank you for your interest in the Area Agency on Aging of Tarrant County's REACH program.

REACH empowers caregivers with loved ones suffering from dementia by supplying them with the tools to meet their needs and overcome challenges.

Register below to get started.

Name*

First Name

Last Name

Phone*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Care Recipient (Person you are caring for)*

First Name

Last Name

What is your relationship to the Care Recipient?*

How would you like to participate?*

Email*