Hebron Community Calendar

April 2024

Sun Mon Tue Wed Thu Fri Sat
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  • Historical Society -…
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  • Historical Society -…
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  • Health Education - C…
  • Board of Assessment …
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  • Hebron Green Committ…
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  • Drug Take Back Day
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  • Democratic Town Comm…
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  • Chatham Health Distr…
Upcoming Events
April 23, 2024
April 24, 2024
April 25, 2024
April 27, 2024
April 29, 2024

Tips for Completion of the Russell Mercier Senior Center Registration Form

Tips for Completion of Form 5- Consumer Registration Form
I. SAMS Details- Personal
f. SSN- This form requests the last four digits of your Social Security
number only; if you wish, you may choose to enter four zeroes
g. Default Agency- Enter NCAAA (North Central Area Agency on
Aging)
IV. Assessment Form- Demographics (continued)
d. Income- You may choose to check “Unknown”
Please be sure to sign the Form 5- Consumer Registration Form, where indicated.
Supplement to Form 5- Consumer Registration form:
Medical Conditions: If none, please check “None”
Allergies: If none, please check “None”
This information is collected for reporting to our current and future funding
sources and is useful for the Senior Center to have, especially during an
emergency.