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Snow Angels Program, Recipient Form
Recipient Application + Waiver
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Full Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Home Address
Your answer
Preferred Contact
Phone
Text
Email
Do you live alone?
Yes
No
Clear selection
Reason for Assistance
Age-related (65+)
Physical Disability
Temporary medical condition
Other
Clear selection
Pets on property volunteers should be aware of
Your answer
Location needing snow removal:
Sidewalk
Driveway
Walkway to door
Other:
Preferred Timeframe
Morning
Afternoon
Evening
No preference
Clear selection
Emergency contact (NAME, RELATIONSHIP, PHONE NUMBER)
Your answer
Submit
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