Name *
Name
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?
DO YOU HAVE SMOKE ALARMS?
WOULD YOU LIKE 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?
DO YOU HAVE PETS?
CAN THE 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?

day of action for seniors - senior sign up form

On November 3rd, 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 INFO

If you have any questions, please call Jazna Stannard: (269) 982-1700 x22 or jazna.stannard@uwsm.org.