WINDHAM SENIORS INC
Town + Zip: ___________________________Phone: _____________________
Birth Date: ____________________________(Year Optional)
My interests are: (check those that apply)
Social Contacts: _____ Trips: _____ Cards: ______ Bingo: _____
Lunch Program: ______ (If you checked this, answer A, B, C & D)
A: Diabetic _____ B: Skim Milk _____ C: Regular Milk _____
D: Can you help in kitchen one day a month? Y ___ N ___
Other interests: _____________________________________________________
Do you have any talents that may be useful to our program, such as playing piano, singing, knitting, crocheting, teach crafts, etc.
Person to notify in case of emergency: ___________________________________
Address: _____________________________________Phone: ________________
Town & Zip: __________________________________
The Officers of the Windham Seniors welcome you to our family. We hope that you have an enjoyable experience. Any suggestions to improve our organization will be appreciated.