CHEER Connect Participant Application

KINDNESS CALLS

Participant Intake & Consent
CHEER has launched CHEER Connect KINDNESS CALLS, a friendly calls program that pairs trained volunteers with older adults for weekly phone check-ins. The initiative combats loneliness and supports well-being through simple, reliable conversation, no clinical advice, just compassionate connection. Participants choose preferred times; volunteers receive training and support, including a masked phone number and easy call logging. CHEER Connect is free for eligible Sussex County residents 50+.
Name:

First NameLast Name
Preferred Name:
Date of Birth (optional)

MonthDayYear
Date
Primary Phone Number
Please enter the number you would like to be called at.
Best days and times to call?
Times NOT to call:
Is it okay to leave a voicemail?

YesNo
Topics to avoid (optional):
Emergency Contact Name:

First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone
Please enter a valid phone number.
CONSENT: By clicking "submit" below, I consent to receive social calls from trained CHEER volunteers and to the secure storage of my contact details and brief call notes for program purposes. I understand this is not a crisis, medical, or case management service. I may opt out at any time.
Please type your full name in lieu of Signature:
Should be Empty:

KINDNESS CALLS