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Senior Center Sign Up Form

  1. Please provide your information below.
  2. Who would you like notified in case of emergency?
  3. The following information is confidential and needed for funding requirements as part of the King County Veteran’s & Human Services Grant.
  4. Which of the following best represents your race? Please check all that apply.*
  5. What gender do you identify as?*
  6. Do you identify as transgender? *
  7. Which of the following best describes your sexual orientation?*
  8. Have you or do you currently service in the military? *
  9. Are you related to someone who is serving or has serviced in the military?*
  10. Leave This Blank:

  11. This field is not part of the form submission.