day of action for seniors - senior sign up form

On November 9th, 2017, volunteers will meet, gather supplies and help senior citizens prepare for winter by raking leaves and cleaning gutters. It will be a day filled with hard work and many rewards. 

IF YOU ARE A SENIOR CITIZEN (60+) WHO IS PHYSICALLY UNABLE TO RAKE LEAVES OR CLEAN GUTTERS, AND CANNOT AFFORD TO HIRE THIS TYPE OF SERVICE, SIGN UP HERE.


SENIOR SIGN UP FORM IS NOW WAITLIST ONLY

The Deadline to sign up was 10/19/17. We will try to get some one to your home if you signed up after that date


Address *
Address
Phone *
Phone
I NEED ASSISTANCE WITH: Check all that apply: *
MY YARD IS:
MY YARD HAS:
DO YOU RENT OR OWN YOUR HOME?
WOULD YOU LIKE TO BE CONTACTED BY AMERICAN RED CROSS VOLUNTEERS TO TEST YOUR SMOKE ALARMS AND FIX OR REPLACE THEM IF NECESSARY?
HOW DO YOU NORMALLY DISPOSE OF LEAVES:
DO YOU HAVE GUTTER GUARDS?
CAN YOUR PET(S) BE SECURED? (if applicable)
ARE YOU A WHIRLPOOL RETIREE?
ARE YOU OR IS/WAS YOUR SPOUSE A VETERAN?
DO YOU HAVE AN AREA AGENCY ON AGING CARE MANAGER?
We ask this because we have volunteer groups from these types of organizations that prefer to serve fellow members.
CAN WE TAKE YOUR PHOTO? *
United Way of Southwest Michigan, a not-for-profit corporation, its legal representatives, successors or assigns, shall have the right to copyright, publish, use, distribute, or assign any and all material submitted by me including, but not limited to, photographic portraits, pictures, images, videotapes and/or sound recordings, any written printed matter, story, or video, in in whole or in part, including my name or other biographical data, in any media whatsoever, now known or hereby created, for the limited purpose of promoting and conducting United Way of Southwest Michigan charitable fundraising or community impact activities.

SENIOR INFO

If you have any questions, please call Julee Laurent: (269) 932.3566 or email julee.laurent@uwsm.org.