Seniors Connect Registration Form

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In this age of digital connections it is hard to imagine people connecting the ways they used to. This can be especially hard for the senior members of our population. Seniors connect is a program designed to connect seniors to each other!

This program pairs seniors with each other so that they can reach out without fear. To participate in this program please fill out the form below. You'll be contacted with the name and information of the person you'll be paired with. The information card will let you know how often to connect and which method works best for them.

We hope that you make some new friends and memories!

Full Name *

Age *

Gender

Phone number *

Email *

If you do not have an email that you can use for contact, please write "N/A".

Mailing Address *

If you'd like to have mail sent you, please fill out your full mailing address including your postal code. If you do not wish to receive any mail then please write "N/A".

Location in Guelph

If you'd like to meet in person please select which general area in the city of Guelph you are located in.

South End

West End

North End

The Ward

Downtown

East End

Prefer not to say

Clear selection

Connection Preferences

There are many ways people prefer to connect! Please fill out what times are generally the best to contact you and which ways you'd prefer. You'll be free to update these preferences during the program. These preferences will be shared with the person you are partnered with!

What is your preferred contact method? *

In general, what is the top preferred method you'd like to be contacted through.

Phone

Mail

In Person Meeting

Zoom or Online Meeting

Other:

How many times a month would you like to be contacted? *

In general, how many times a month would you be comfortable connect with another person?

1 - 2

2 - 4

5 +

Interests and Hobbies

In order to help you connect better, we want to know a little more about what your interests and hobbies are. Please take a moment to answer some of the questions below. The responses to this will be shared with your connection!

My hobbies and passions include:

Please list out some of your hobbies or passions. You can write in sentences or in list form.

In my spare time I like to:

Please write out what you like to do in your spare time. You can write in sentences or in list form.

I'm looking to connect with someone who enjoys:

Please write out what type of topics you'd like your connection to be interested in. You can write in sentences or in list form.

Thank you for your response! You'll receive a confirmation email soon!

Thank you for your interest in being apart of the Seniors Connect program! We are so excited to connect you with another seniors soon. Please feel free to contact us if you have any comments, questions, or concerns by phone at: 519 824 6340 or by email at: pgng96@gmail.com.

Have a great day!

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