Teen Application for Snow Shoveling

Teen Application for Snow Shoveling
The Village of Arlington Heights Snow Shoveling Ref err al Program provides Arlington Heights residents who are over age 60 or who have a disability with the names and contact information of teens willing to shovel snow.

By participating in this snow shoveling referral program and providing your contact information, residents wanting your assistance will be provided with a list of teens willing to shovel snow in their area. The resident is responsible for contacting the teen and for making the scheduling and financial arrangements. The teen is responsible for completing the show shoveling or notifying the resident if they are unable to complete the work.
Contact Information

First NameLast Name
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
School
Birth year
I hereby agree that I will indemnify and hold the Village of Arlington Heights harmless of and from any and all claims that may be made by any person or organization for personal injury and property as a result of participation in this Snow Shoveling Referral Program.
Sign Here
Date

MonthDayYear
Date
Parental Consent

Parental or Guardian Signature is required if the applicant is under age 18. Hard copy is required for applicants under age 18.
Sign Here
Date

MonthDayYear
Date
Should be Empty:

Parental Consent