Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Freedom From Smoking Class Registration Form

  1. Freedom From Smoking Class Registration Form

    Use this form to register for the health department's 7 week quit smoking class. Classes are held every Monday for 8 sessions beginning January 7, 2019 at the Human Services Building, 1040 S. Winter Street Adrian, from 6-8pm in the Demo Kitchen.

  2. Class flyer is available!

    Click for class flyer.

  3. Thank you!

    If you have questions, please contact Becky Selenko at the health department or 517-264-5253.

  4. Leave This Blank:

  5. This field is not part of the form submission.