GrandChat Video by The M.A.C.H.O. Foundation  Senior Sign Up
Are you a senior?  Do you have a senior loved one? You're in the perfect place!  Simply complete the form below to sign up for a GrandChat Video!  We will connect you or your senior loved one for a ten minute video chat with one of our amazing volunteers!  Seniors have so much wisdom to share with the younger generations and sometimes just need a new audience.  All human beings, regardless of their age often feel lonely and isolated and we believe that connecting with one another can help to put a smile on all our faces.  So join us!              
THERE IS NO LONG TERM COMMITMENT AND THIS SERVICE IS 100 PERCENT FREE.  You may sign up one time or be a repeat customer.   The choice is yours!
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 Senior Last Name *
Senior First Name *
Senior Phone Number *
Current Age of Senior
City and  State where senior lives *
Who is completing this form? *
Full Name of Person Completing this form (If different from senior)
 Email Address of person to contact to set up GrandChat Video *
Phone number of person to contact (if different that Senior)
GrandChat Video will work on a monthly schedule. Please choose a date or MULTIPLE DATES that will work for you/your senior loved one.  We will confirm the date and time with you via email. *
Required
Please check off the preferred times for your GrandChat Video . All video chats will begin at the start time below and last approximately ten minutes. (YOU MAY CHECK ALL THAT APPLY). We will confirm the date and time with you via email. *
Required
Likes and dislikes  - What are you some things you/your senior loved one like or dislike?  Do like to take long walks or garden? Were you a  basketball star back in the day or did you fly airplanes?   Share anything you'd like us to know!
It is important to us that our GrandChat Video calls bring a smile to your face/the face of your senior loved one.  If there are any sensitive topics that you would not want to discuss or any important information you would like us to know about you or your senior loved one, please share below.
In order to participate in a GrandChat Video call you will need to be able to do one of the following 1) Receive an email and click a link which will begin my video chat call 2) Receive a Skype Call 3)Receive a Facetime Call *
In order to help us chat with more and more Seniors, we may choose to record your GrandChat Video WITH YOUR permission.  Video or audio clips of this "GrandChat" may be used for any advertisements including and not limited to television, radio and all social media outlets. (ie Facebook, Instagram, Twitter etc)  YOUR FULL NAME WILL NEVER BE DISCLOSED.  Please remember this service is 100 percent free for all involved and our one and only goal is bring people together for some smiles. *
Any additional questions or comments you may place below.
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