Make a Senior Smile Day Request

Make a Senior Smile Day Request

November 7 & 8, 2025.
Volunteers will be raking yards on November 7th and 8th. Due to the work involved in coordinating volunteers, residents will not be able to choose their date.

Deadline for submitting requests and/or nominations is Monday, November 3rd.
Address that needs raking:*
Is this your residence?*

YesNo
Your Name*

First NameLast Name
Your Phone Number*
Please enter a valid phone number.
Your Email*
example@example.com
Name of Resident*

First NameLast Name
Resident's Phone Number*
Please enter a valid phone number.
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.
Requestor's Email*
example@example.com
Which part of the yard needs raking? (Check all that apply)*

FrontBack
Estimated number of leaf bags needed:*
Please give an estimate of how many bags:*
Have we raked this yard in previous years?*

YesNoI don't know
Any additional information we might need:
Should be Empty: