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2. SNOW ANGEL REQUEST FORM

   Franklin Park Borough

   Requirements:  60 years of age or older or have a physical disability

   
   

   
   

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Alternate Phone Number
16. Email Address*
18. Neighborhood/Plan Name*

19. Enter N/A if not in a designated neighborhood/plan.

21. Do you have any disabilities?*
    -- Select One --YesNo
23. If so, please disclose to the level that you are comfortable.
25. Are you 60 years of age or older?*
    -- Select One --YesNo
27. Do you have any alternative snow removal resources (family, friends)?*
    -- Select One --YesNo
29. I/we would like a volunteer to help with shoveling my sidewalk/walkway up to my front door/primary entry to residence.*
    -- Select One --YesNo
31. I/we would like a volunteer to help with shoveling my driveway.*
    -- Select One --YesNo
33. Do you have a shovel available to use?*
    -- Select One --YesNo
34. Do you have salt available to use?*
    -- Select One --YesNo
36. If yes, please let us know where it will be located.
37. If yes, please let us know where it will be located.
39. Did you fill this form out on someone else's behalf?*
    -- Select One --YesNo
41. If yes, enter your full name, relationship, phone number and email address where you can be reached.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field