Snow Shoveling Referrals Request
The Village of Hinsdale Snow Shoveling Referral Program provides Hinsdale residents who are over the age of 60 or who have a disability, with the names and contact information of volunteers willing to shovel snow. The resident is responsible for contacting the volunteer and for making the scheduling arrangements. The volunteer is responsible for completing the snow shoveling or notifying the resident if they are unable to complete the work.
Contact Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternative Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
I qualify for the snow shoveling referral program because
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I am at least 60 years old.
I have a disability which precludes me from shoveling snow.
Requested Areas to Be Shoveled
*
Driveway
Sidewalk (in front of home)
Personal sidewalks
Steps
Other
Do you have a shovel for volunteers to use?
*
Yes
No
Consent and Agreement
Upon request, the Village of Hinsdale will provide referrals of teenagers who are willing to shovel snow for the Village of Hinsdale residents, age 60 and over or residents who have a disability that precludes them from shoveling snow. The resident will contact the teen and make all arrangements with the teen to have their snow shoveled. The teen snow shoveler and the resident work out all details as to: areas to be shoveled, time to be shoveled, cost of job and payment arrangements. The Village of Hinsdale makes no guarantees about this program. I agree that I will indemnify and hold the Village of Hinsdale 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. I have read the above description of the snow shoveling referral program and understand and agree to the terms. My signature below indicates this understanding and agreement and certifies that the information I have provided is accurate.
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Submit
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