Form Center

2. 
4. Teens Helping Seniors Request for Work to be Completed

6. Thank you for submitting your work request for the Teens Helping Seniors. As a reminder, THS can help you with light housework, yard work, raking leaves, and several other small household projects. The fall program serves seniors on Saturdays only.

   This program is available for seniors aged 55 and older. Donations are gladly accepted.

8. Today's date*
   Today's date
9. Requester's Name*
10. Requester's Phone Number*
12. Email Address (if available)
14. Requester's Address*
16. City*
17. Zip*
19. Preferred date and time for work to be done*
    Preferred date and time for work to be done

    Preferred date and time for work to be done

    This program only performs work on Saturdays 9:15 am-4:15 pm.

21. Describe type of work to be done*
23. 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.

    1. I agree.
25. Electronic Signature
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field