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Yakima and Selah Neighbors’ Network
PO Box 11691, Yakima, WA 98909
(509) 853-1917

Say YES to staying in your home.

Say YES to Community! Come together with others to improve life for all of us.

Say YES to give and receive personal help with the YESneighbors network.

Make aging at home an affordable, viable and exciting option.
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HomeMember Application


MEMBER APPLICATION

GENERAL MEMBER INFORMATION

 

Name:

 

Date of Birth

 

Name:

 

Date of Birth

 

Address:

 

City

Zip

Home Phone:

 

Cell Phone:

 

Email:

 

 

 

Communication Preference: Phone

 

Email

Text

 

EMERGENCY CONTACT INFORMATION

Name:

 

Relationship

 

Address:

 

Phone No(s):

Email:

Name:

 

Relationship

 

Address:

Phone No(s):

Email:

 

 

Membership Fees: Individual $300/yr Household (2) $400/yr

Payable by cash or check

YSNN MEMBER BENEFITS

 

Services from our list

Invitations to social events

Invitations to educational events

Website articles and information

Preferred contractor list

Being a volunteer

We will be adding services as we grow.

 

 

 

SERVICES

 

 

Put check mark by services you are interested in receiving: If you do not yet need these services, would you be willing to volunteer to offer these services: Put a “V” by services for which you are willing to volunteer.

 

Transportation (appts., shopping, errands)

 

Computer/technology

 

Grocery shopping or errands for you

 

Visiting/check-in calls

 

Referrals to local providers

 

Reading

 

Light yard work

 

Snow shoveling

 

Minor household repairs/maintenance

 

Walking/exercise partner

 

Emergency pet care

 

Light housekeeping

 

 

 

 

 

How did you hear about Yakima and Selah Neighbors’ Network?

 

 

Do you have a pet?

 

What kind?

 

How Many?

 

 

Are you a smoker?

 

 

Are there any current health needs or chronic conditions that would be helpful for us to know? If yes, please describe.

 

 

 

 

 

I hereby apply for membership and give permission for YSNN to use photos of me at YSNN events for promotional purposes.

 

Signature:

 





For more information contact YSNN:

Phone: 509-853-1917

Email: ysnn.wa@gmail.com

Mail:  PO Box 11691, Yakima WA 98909