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Seniors Snow Removal/Lawn Maintenance Referral Form

  1. Available Times

    Select all that Apply

  2. Give a range of Hours

  3. Check of the following service you are able to provide:

  4. Volunteer Snow Removal

  5. Paid Service Snow Removal

  6. The cost of services gives the Coordinator an idea of cost to be passed along to the person seeking these services. Please keep in mind that a lot of our services users are people on fixed income.

  7. Bobcat Servies

  8. Shovelling Services

  9. Mowing and Trimming

  10. This is a referral service as agreed upon; Calls will be directed to individual above for snow removal and Lawn Maintenance service. All individuals looking for this service are aware that there will be a cost which will be agreed upon between the referral and the service provider.

  11. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  12. Leave This Blank:

  13. This field is not part of the form submission.