Sign Up for Senior Angels at EMCC
Fill out the form below. If you have trouble you can call Kayla Winters at (317) 916-9064 to sign up or visit our office at 37 Place.
What are some of your interests and hobbies?
Do you have medications you take on a regular basis?
Are you interested in receiving senior commodities?
Will you need transportation on program days?
Which program days will you participate in (check all that apply)?
Please list someone whom we can contact for you in case of an emergency.
Relationship to you:
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