Creating Connections - Art PenPal (art gift only) sign up form
This form is for those Seniors, an/or those representing Seniors in the Greater Trail Area, wanting to sign up for the FREE Art PenPal program this winter and have a special piece of art made by a local student just to them.

Please fill out this form as best you can and let us know if you have any questions: director@visacgallery.com

1 form per Senior, if there are multiple seniors from the same address, we need each one to fill out a form please. You may fill this out for a senior you know as a surprise.

We keep all the art gifts and materials for 5+ days in a secure spot before sending them out.

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Senior Name *
What city do you/they live? *
Do you/they live in a low income housing and/or Seniors housing?
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If you answered yes, please give the name of housing/facility.
Example: Silver City Housing, Trail Villa Housing, etc.
What is your/their full address please *
What is your phone number?
In case our delivery team has trouble finding the address for example.
Are there any special directions the delivery team should know about in order to ensure an easy delivery?
Example: Please leave under deck, at end of long driveway, etc. ***Please note: they will be knocking/ringing door bells and then leaving packages at the door, not waiting for an answer***
We will be sending out an email when the estimated delivery date/time will be. Right now we are projected for the 1st week of February. May we please have your email address in order to send you updates about your delivery? *
Any other notes or questions?
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