red arrow Location:
571 Petersburg Road
P.O. Box 204
Dennisville, N.J. 08214
Phone & Fax: 609-861-3137
red arrow right Email: Senior Center
 Official Web Site of:
The Township of Dennis
County of Cape May
New Jersey
Senior Citizen Center		 red arrowHours:
Dennis Township Senior Center
We are open daily
from 8:30 a.m. to 4:00 p.m.
Monday thru Friday
red arrow right Email: Senior Center
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SeniorCenter.DennisTwp.org
The Dennis Township Senior Citizen Center is a section of the official Dennis Township web site, www.DennisTwp.org.

Township of Dennis
571 Petersburg Road
Dennisville, N.J. 08214
Phone: 609-861-9700
 
Dennis Township Senior Citizen Center
Special Needs Online Form

TOWNSHIP OF DENNIS
OFFICE OF EMERGENCY MANAGEMENT
571 Petersburg Road

Dennisville, NJ 08214

 Dennis Township Senior Center Logo

SPECIAL NEEDS ONLINE FORM - 2010

Name of person with Special Needs:
    - Name (Required)
    - Address (Required)
    - Address
    - City (Required)
    - State (Required)
    - ZIP/Postal Code (Required)
    - Home Phone (Required)
Description of Special Needs:
    Wheelchair Bound
    Dialysis Patient
    Diabetic
    Hearing Impaired
    TTY/TDD
  
    Special Medications
    Oxygen
    Blind
    Uses Seeing Eye Dog
    Language Barrier
Additional Information:

Special Instructions:

Individual Completing Form:
    - Name (Required)
    - Address (Required)
    - Address
    - City (Required)
    - State (Required)
    - ZIP/Postal Code (Required)
    - Home Phone (Required)
    - Work Phone
    - Email
    - Date (Required)
        

THE INFORMATION CONTAINED ON THIS SPECIAL NEEDS FORM MAY INVOLVE PERSONAL MEDICAL INFORMATION WHICH IS NOT SUBJECT TO THE STATE RIGHT-TO-KNOW LAWS. THE INFORMATION ON THIS FORM IS CONSIDERED PERSONAL AND PRIVATE AND IS PROVIDED FOR THE SOLE PURPOSE OF DEVELOPING A SPECIAL NEEDS DATABASE TO BE UTILIZED BY THE TOWNSHIP OF DENNIS OFFICE OF EMERGENCY MANAGEMENT, AND/OR ANY OF ITS DESIGNATED AGENTS ASSOCIATED WITH THE 9-1-1 DISPATCH CENTER.
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Dennis Township Senior Citizen Center, 571 Petersburg Road, P.O. Box 204, Dennisville, N.J. 08214-0204 - Phone: 609-861-3137

Township of Dennis Senior Center Official Web Site:
SeniorCenter.DennisTwp.Org
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