Application For Membership

You are in the right spot if you are an older adult applying to receive 'A Little Help' from our volunteers.

The application will only take a few minutes and once it is submitted you will receive a call within 2 weeks from our Member Coordintor to discuss your application and verify your information.

We look forward to having you join the A Little Help community.

CONTACT INFORMATION

First Name *

Last Name *

Date of Birth *

Day

Month

Year

Gender *

First Name

If more than one individual living in your household, please complete with Family Last Name

Last Name

Date of Birth

Day

Month

Year

Gender

Address: Physical *

City *

Zip Code *

Do you want to receive your mail at a different address?

Yes

Mailing address / PO box

City

State

Zip Code

Home Phone *

Mobile

Marital Status *

Are you fully vaccinated against Covid-19? *

Yes

Race/ethnicity

Other

Primary language (if not English)

Other

FAMILY & NEIGHBOR CONTACT INFORMATION

How many people live in your household, including yourself? *

Contact 1

Name *

Relationship *

Address *

Phone *

Emergency contact?

Emergency Contact?

Contact 2

Name

Relationship

Address

Phone

Emergency contact?

Emergency Contact?

Contact 3

Name

Relationship

Address

Phone

Emergency contact

Emergency Contact?

RECIPROCAL RESPECT AGREEMENT

The only way A Little Help can operate is if there is a mutual respect among our members.

I understand that A Little Help is not solely a service provider but is also, and more importantly, a community. To that end, I will treat all members of A Little Help with respect and can expect such in return.

If accepted, A Little Help reserves the right to cancel my membership if I am in violation of this community agreement.

Respect Agreement

I understand

WAIVERS

I (we) waive any right or cause of action arising as a result of participation in A Little Help from which any liability may or could accrue against A Little Help or its officers, staff, and directors collectively or individually.

A Little Help reserves the right to utilize the contact information provided to share our mission with your contacts.

Permission for photos

I give permission to use photos taken at A Little Help events for promotional purposes

Signature *

Date *

Day

Month

Year

Becoming a member of A Little Help means you’re joining a caring community of neighbors who want to see people of all ages thriving in our neighborhoods. Operating a nonprofit, even a volunteer-driven organization, costs money. The average cost to navigate services for our older adults is $1,000/year. That cost is greatly subsidized by the generosity of our grantmakers and members of every kind. Our members pay what they can.

We receive funding from our local Areas on Aging for our transportation and certain services for older adults 60+. If you are applying and eligible for these programs, there is no obligation to contribute towards an annual membership and help will not be denied if you choose not to contribute.

Are you willing to contribute to A Little Help? If so, please indicate what you pledge to contribute for your membership when your application is accepted:

If my application is accepted, I pledge to contribute

Other amount $

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Application For Membership

Metro Denver: 720-242-9032

Western Slope: 970-404-1923

Northern Colorado: 970-412-9396