Skip to Main Content
Public Alerts
Coronavirus Information
Read On...
Departments
Community
Business
Government
Public Safety
City Connection
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Arts & Culture Division
City Manager
CivicPlus Test Category - Please Ignore
CivicPlus Test Category 2 - Please Ignore
DIMO
ECIA Grants
Mayor
Planning & Building Regulations
Police Department
Recreation
Rent Program
Richmond Art Center
Richmond Department of Children and Youth
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Adopt-a-Senior Report Form
This form has been modified since it was saved. Please review all fields before submitting.
Adopt-a-Senior Report
Volunteer First Name
*
Volunteer Last Name
*
Date of Service
*
Date of Service
Address of Your Adopted Senior
*
City
*
State
*
Clean-up Metrics
Hours of service
*
Square footage of space painted
*
Estimated weight (in pounds) of all
litter
removed (food wrappers, plastic bags, etc.)
*
Estimated weight (in pounds) of all
yard waste
removed (grass, weeds, etc.)
*
(Optional) Share some photos with us!
(Optional) Upload a before image from your service
(Optional) Upload a during or after image from your service
(Optional) Upload an image with your adopted seniors
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
Submit and Print
* indicates a required field
Charter
District Elections
E-News Signup
Municipal Code
Richmond Coronavirus Info
Streaming Video
Weekly Announcements
ADA
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow