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Agency Participation Form - Community Days 2023
Please submit by May 18, 2023. Thank you!
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* Indicates required question
Select all the dates that your agency will participate. Each event is from 4 p.m. to 6 p.m.
*
Community Day 1, May 25th - Newhouse Park, 2960 Alston Drive
Community Day 2, June 8th - Rickarby Park & Center, 550 Rickarby Street
Community Day 3, June 22 - Sullivan Community Center, 351 N. Catherine Street
Community Day 4, July 6 - Kidd Park, 800 East Street
Required
Agency Name
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Your answer
Agency Address
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Your answer
Contact Person
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Your answer
Phone Number
*
Your answer
Email Address
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Your answer
Select the type of resources you will provide at the Community Days events.
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Health Care or Dental Care
Employment Opportunities
Substance Abuse and/or Mental Health Services
Educational Opportunities
Required
We request that each participating agency has a game or fun engaging and educational activity at its table. Briefly describe what you will set up.
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Your answer
How can we assist you with setting up?
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I need a table.
I need one chair.
I need two chairs.
Required
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