Senior Resource Council
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Referred By
Primary Representative
Organization Name
Address
Zip
Phone
Fax
Email
Company Web Address
Secondary Organization Representative
1)
Email
2)
Email
Additional Organizational Representatives ($20.00 each):
1)
Email
2)
Email
SERVICE CLASSIFICATION
This is how you will be listed in the website. (Please check all categories and
circle
sub-categories that apply):
Products & Services
(Moving Assistance, Medical Equipment, Transportation, Home Modification, Care Coordination)
Education & Government
Financial, Legal
(Elder Law Attorney’s, Financial Managers, Funeral Pre-Planning, Reverse Mortgage)
Home Health
(General Healthcare, Non-Medical, medical)
Recreation
Housing
(Independent, Retirement, Assisted, Skilled, Alzheimer’s Realtor)
Nutrition
Recreational
Organization & Groups
Crises Resources
Contacts
Senior Resources
(Adult Day-Care)
Hospice
(In-Home, Residential Facility)
Insurance
(Medicare Advantage Pro, Medicare Supplement Plans, Prescription Drug-Medicare Part D, Long-Term Care)
Code of Ethics for Senior Resource Council Members
I agree that I have all necessary licenses, insurance and bonds required for my profession or occupation.
I agree that I am in compliance with all statutes, ordinances, regulations and rules that govern my profession or occupation.
I agree that in practice of my profession or occupation, I respect the inherent dignity and autonomy of seniors.
I agree that in my marketing efforts at all events sponsored by the Senior Resource Council, I will not use tasteless and/or overt promotion, but will provide information about my products or services designed to inform seniors and their families.
Get Involved
I want to learn more about the Following Committee(s):
Grandparents Raising Grandchildren Seminar: A half day seminar providing valuable resources and support for Grandparents who are raising their grandchildren
Holiday Dinner Dance: Participate in the planning and coordination of this annual event that feeds and entertains approx 500+ local seniors and their family.
Joe Henjum Senior Accolades : An annual community-wide special event to honor an outstanding youth, Individual, and senior, and a business/organization recognized for their commitment toward quality of life for seniors in the greater Pikes Peak region.
Education and Monthly Events: Active members who help select topics for monthly meetings.
S.A.F.E. (Safe Aging For Everyone) Conference: Assist in the planning and coordination of this annual event which educates community members on variety of ways to age safely.
Boomer and Senior Expo: Participate in the planning and coordination of the SRC’s annual fund-raiser, an exposition involving seniors and senior service providers.
Senior Housing Directory: Assist in the formation of this annual publication that informs seniors of their choices when it comes to local senior housing.
Please read the following carefully and sign where indicated
I certify to the best of my knowledge that the information contained in this application is true and complete. By photocopy of this application containing my signature, I authorize the Senior Resource Council, (SRC), to conduct reasonable reference and background checks as deemed necessary relative to my ability to perform volunteer work and agree to hold the SRC, its employees, and volunteers harmless and without liability for their actions in conducting background checks. Further, I agree to release SRC from any and all liability arising from, but not limited to, any injures, impairments,or loss of life or limb sustained by me while performing services for the Senior Resource Council. I am offering my services as a volunteer with the understanding that I will not be financially compensated. I acknowledge that my membership may be terminated if I have made any misrepresentations in this application. I further acknowledge that my membership may be terminated if I do not adhere to the membership code of ethics
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