Note: This form is still being created. We apologise for the inconvenience.

Adopt a Senior - Donor Application

Welcome to the Adopt a Senior program! Our aim is to make this year a little brighter for the senior's in our community!

Email address *
Please fill out the below information:
Name *

Address *

Phone Number *

How would you like to be involved?
Please select all that apply:

I'd like to adopt a senior!
- 250€ adoption donation
- 100€ adoption donation
- 50€ adoption donation
- 25€ donation (Keeping in Touch)
- 10€ donation (Keeping in Touch)
- General donation ...

I'd like to volunteer!

We greatly appreciate your participation in the Adopt a Senior program.

Once applications have been collected, donors and seniors will be matched up. In an effort to protect everyone's privacy, personal information will not be released.
Have questions? Please feel free to leave your questions here!