Rake Up Green Bay Service Request Form

Rake Up Green Bay Service Request Form

To be considered for assistance, you must complete and submit this form by September 27. Please note, however, submitting this form doesn’t guarantee service.
Information about the person needing service:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Who should we contact with questions?*

The person named aboveSomeone else
If someone else, their name:

First NameLast Name
Phone Number
Email
Relationship to person needing service:
What is your reason for requesting this service? Due to limited resources, we would like to focus our efforts on the homeowners in our area who are most in need.*

No one else in the area to assistPhysical disabilityFinancial limitationsOther
Approximately how many leaf-dropping trees does your yard have (front and back combined)?*
Do you have a pet? Please note: Homeowners are responsible for clean-up of pet waste in their yards prior to volunteers' arrival.*

NoDogCatOther
Can you provide any rakes and, if so, how many?*
Can you provide any tarps and, if so, how many?*
How did you hear about this opportunity?*

ADRC of Brown CountyVolunteer Center of Brown CountyOther
I give permission for my photo to be used by the participating organizations for promotional purposes.*

YesNo
Please read before submitting:

I understand that volunteers do the work. I release from any and all liability the volunteers, the Volunteer Center of Brown County, and any partnering or sponsoring agencies through my consent to participate in this program. I understand that this request may not be completed due to resource limitations and at the discretion of the Volunteer Center. I give permission to release my contact information to the volunteer(s) assigned to me so they may contact me to arrange a day and time for the services(s) to be completed. I acknowledge my understanding of the above-mentioned information and my willingness to participate in this program.
Signature

Clear
Thank you for completing this form!

If we are able to match you with a group of volunteers, they will contact you to arrange a day and time that works for you both.

Please note: Volunteers won't begin contacting homeowners until mid-October.
Should be Empty:

Rake Up Green Bay Service Request Form

Information about the person needing service: