Citizens' Center
For Your Information
SURVEY OF INTEREST
VISUAL ARTS/CRAFTS PERFORMING ARTS
___ Painting (acrylic, oil, water color, etc.) ___ Music (instrumental, singing)
___ Needlework / sewing / quilting ___ Drama
___ Woodworking ___ Comedy
___ Other (specify: ____________________) ___ Square dance, folk dance, etc.
___ Other (specify:__________________)
RECREATION SOCIAL EVENTS
___ Shuffleboard ___ Potluck meals
___ Horseshoes ___ Holiday / seasonal parties
___ Track & field sports ___ Cookouts / picnics
___ Fishing ___ Monthly dinner with entertainment
___ Golf ___ Other (specify: _________________)
___ Travel (___ day trips; ___ overnight trips)
___ Cards / Other games
___ Other (specify: _____________________)
VOLUNTEER OPPORTUNITIES COMMENTS / SUGGESTIONS:
___ Group or Activity Leader ___________________________________
___ Activity Assistant ___________________________________
___ Assist Center Staff ___________________________________
___ Do Blood Pressure Checks, ___________________________________
or other Health Screenings ___________________________________
___ Teach a class (subject: ______________) ___________________________________
___ Assist seniors with Insurance, other business ___________________________________
___ Serve as �Ambassador� for seniors ___________________________________
promoting public support ___________________________________
___ I would be willing to serve as a volunteer group or activity leader or assistant
in the area of _____________________________________________________.
___ I could serve as a group or activity leader if I received a stipend (a small payment
to help cover expenses) in the area of __________________________________.
(Optional)
Name: ____________________________________ Phone # ______________________
