YARD CLEAN-UP SENIOR APPLICATION

REQUEST FOR YARD CLEAN UP

If you are a senior or you care for a senior and would like to apply for a Yard Clean Up, simply fill out the form below. Once we receive your application, we will review your information and contact you to schedule.

If you have any questions about Yard Clean Up, please call us at 630-620-0804 or email us.

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Senior Yard Clean Up Days Application

SECTION 1:
Do You Own Your Home?Select One
Do You Speak EnglishSelect One
SECTION 2
Do You Live Alone?Select One
Do You Share Your Home With Others?Select One
How Many People In Your Family Are Over 60 Years Old?Select One
Is Your Household Income Over $11,1870 per year?Select One
What Is Your Household Income?
SECTION 3
Emergency Contact Information
SECTION 4
Do You Have Someone Who Helps You With Yardwork?Select One
If Yes, Who Helps You?Select One
What Is The Size Of Your Yard?Select One
Do You Have A Dog?Select One

I understand that the people who work at my house on Yard Clean Up Days are volunteers and that they will respect my privacy and maintain confidentiality. I agree to allow volunteers to complete the projects agreed upon by the DuPage Senior Citizens Council (DSCC). I understand that there is NO GUARANTEE that DSCC would be able to support all applications. I agree to indemnify and forever hold harmless DSCC, municipalities, volunteers, board members and any and all other organizations, agencies, public and private funding sources associated with the Yard Clean Up Service for any and all liability and responsibility for any claims, injuries, participation in the project. I give permission to DSCC to share general information that could benefit other seniors. Your personal information will remain confidential.

AgreementI understand the terms above. Clicking this BOX is my digital signature.
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“The weather really played havoc on getting the work done. But they worked in the mist and pending darkness. It was great to see everyone working hard to get the job done. My yard looks great and I wouldn’t be able to do it myself.”

– Doris

Doris

YOUR SUPPORT MEANS EVEN MORE THAN YOU KNOW
When you give your time or resources to DSCC, it directly helps our seniors.

Your donation makes all the DSCC services possible. Get involved in the services we provide for seniors.