JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lower Umpqua Senior Center
Activity and Resource Survey
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Have you ever visited the Lower Unpqua Senior Center in Reedsport?
A couple of times
Often
I visited regularly in the past
Never
Other:
Clear selection
What types of activities would you be interested in having at the senior center?
Fishing or Crabbing Group
Senior Exercise
Cards and Games
Puzzle Group
Book Club
Music and Dance
Pool, Chess or other tournaments
Electronics Classes
Suppport Groups
End of Life Planning
Other:
Clear selection
What kind of resources would be helpful to you and your needs?
Vetrans Services
Medical Advise and Information
Social Security
Trusts, Wills
Oregon Senior Services (DHS)
Retirment Planning
Finance
Community Volunteer Opportunities
Clear selection
Please share resources or activities that you feel would improve our local senior center.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
