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Dear Geauga County Senior,
Every year we must have a new registration form completed on any client who receives a service through the Department on Aging or attends one of our senior centers.
Please complete the 2012 registration form (which in located on this website) and return to the Department on Aging located at 12555 Ravenwood Drive, Chardon Ohio 44024. On page 1- where it asks for your SSN- we only need the last four digits of your social security number. Page 2 asks health/nutrition questions to help link seniors to programs they may qualify for. Page 3 is extremely important as it will update your current emergency contacts and medical information. Once we have received your completed 2012 registration form, a yellow colored 2012 membership card will be mailed to you. This card will enable you to receive discounts on the many senior events that are offered throughout the year.
Although many of you have completed this form in the past, it is necessary to complete a new one every year. It is vital that the Department has updated information for every senior who receives services from us. If you ever fell or got hurt when you were with us, we would be able to let medical personnel know what medications you are currently taking and if you are allergic to any medications.
In order to receive services in 2012, this form needs to be completed and returned to the Department on Aging. This information is kept confidential and is not released to others without written permission. If you have any questions, please call 279-2130, 834-1856 or 564-7131 at ext. 2130.
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