Make a Senior Smile Day Request

Make a Senior Smile Day Request

November 14, 2026
Volunteers will be raking yards on November 14th.

Deadline for submitting requests and/or nominations is Monday, November 9th.
Address that needs raking:
Is this your residence?
Your Name

First NameLast Name
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email
example@example.com
Name of Resident

First NameLast Name
Resident's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Resident's Email
example@example.com
Age of Resident
Name of person submitting request

First NameLast Name
Requestor's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Requestor's Email
example@example.com
Which part of the yard needs raking? (Check all that apply)
Estimated number of leaf bags needed:
Please give an estimate of how many bags:
Have we raked this yard in previous years?
Any additional information we might need:
Should be Empty: