Neighbor to Neighbor Participant Application

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This application is required of all participants in the Neighbor to Neighbor program. This program is intended for neighbors over the age of 60 in the Town and Village of New Paltz.

Please complete the questions below and you will be contacted by a Volunteer shortly.

In lieu of completing the online form you may print this page and complete and mail to the Village of New Paltz at:
Neighbor to Neighbor Program
Village Hall
25 Plattekill Avenue
New Paltz, NY 12561

I certify that I am a resident of the Town or Village of New Paltz. *

I agree

I disagree

I certify that I am 60 years of age or older. *

I agree

I disagree

First name. *

Last name. *

Street

City *

State *

Zip *

Phone number. *

Email address.

Emergency contact #1 name. *

Emergency contact #1 address. *

Emergency contact #1 relationship. *

Emergency contact #1 day phone. *

Emergency contact #1 night phone. *

Emergency contact #2 name.

Emergency contact #2 address.

Emergency contact #2 relationship.

Emergency contact #2 day phone.

Emergency contact #2 night phone.

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