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Fitchburg Senior Center 2024 Registration
Thankyou in advance for completing our yearly participant information form. The data we collect provides us with a better understanding of user characteristics so we can continue to meet the programming, services and funding needs now and into the future.
If you are a participant onsite with any of our programs, we strongly encourage you to fill out our emergency contact form link here:
-EMERGENCY CONTACT FORM-
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First Name
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Last Name
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Address
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City
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Zip Code
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Email (No Email? Enter N/A)
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Phone Number
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Race/Ethnicity
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Asian
Black
Hispanic
Indigenous
Native Hawaiian or Other Pacific Islander
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Other:
Gender
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Male
Female
Transgender Male
Transgender Female
Other:
Age Group
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50-60
61-70
71-80
81+
What Brings You In Or To This Page Today?
Physical Fitness
Education/Presentation
Social Well-being
Emotional Well-being
Health Promotion
Arts/Crafts
Card Games Etc..
Other:
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