Senior Activity Attendance Form
Please complete this form to record your attendance and participation in community center activities.
Full Name
*
First Name
Last Name
Date of Attendance
*
-
Month
-
Day
Year
Date
Please select the activity you are attending today
*
Please Select
Arts & Crafts
Exercise Class
Board Games
Cooking Workshop
Book Club
Music & Singing
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address (if available)
example@example.com
Age
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or allergies we should be aware of? (Optional)
How would you rate your experience with today's activity?
1
2
3
4
5
Additional Comments or Suggestions
Signature (Please sign to confirm your attendance and agreement)
*
Submit Attendance
Submit Attendance
Should be Empty: