Teen Snow Shoveling Program Application 2022

Teen Snow Shoveling Program Application 2023-2024
Thank you for your interest in the Somerville Snow Shoveling Program. Enclosed you will find a copy of the Snow Shoveling Application, Waiver of Liability and the CORI Form. We would like to remind you that not everyone will be matched, although it is our intention to match all applicants.

Program Requirements:
- Applicant must be able to pass the CORI check.
- Home must be owner occupied.
- Home cannot be larger than a 3-family.
- Applicant must be age 60 or over or disabled.
Please note that if a snowstorm happens during school hours you must wait to contact the shoveler until after school hours. Additionally, you must use the shoveler consistently throughout the snow season. If there is a problem, please feel free to call Daniel Harris at 617-625-6600 ext. 2406. If the slots are filled you will be placed on a waiting list until a shoveler becomes available.

For assistance with completing this application and to discuss the completion of the CORI form, please contact Debra Higgins at the Somerville Council on Aging, 617-625-6600 ext. 2321.
Name*

First NameLast Name
Email*
example@example.com
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.
Are you at least 13 years of age?*

YesNo
Will you be 18 years of age by April 30th?*

YesNo
Do you have a shovel?*

YesNo
Mode of Transportation*
Name of Parent or Guardian*

First NameLast Name
Relationship to You*
Parent/Guardian Phone Number*
Please enter a valid phone number.
Participant Signature*

Clear
Parent/Guardian Signature*

Clear
Should be Empty:

Teen Snow Shoveling Program Application 2023-2024