Location:571 Petersburg Road P.O. Box 204 Dennisville, N.J. 08214 Phone & Fax: 609-861-3137  Email: Senior Center |
Official Web Site of: The Township of Dennis County of Cape May New Jersey Senior Citizen Center |
Hours: Dennis Township Senior Center We are open daily from 8:30 a.m. to 4:00 p.m. Monday thru Friday Email: Senior Center |
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TOWNSHIP OF DENNIS - OFFICE OF EMERGENCY MANAGEMENT |
SPECIAL NEEDS ONLINE FORM - 2012
Name of person with Special Needs:
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Description of Special Needs:
Dialysis Patient Diabetic Hearing Impaired TTY/TDD |
Oxygen Blind Uses Seeing Eye Dog Language Barrier |
| Additional Information:
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Special Instructions:
- Address (Required) - Address - City (Required) - State (Required) - ZIP/Postal Code (Required) - Home Phone (Required) - Work Phone - 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 2011 Township of Dennis. All rights reserved. |
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Web Site Designed & Maintained by: "Power Of Production Studio" Web Comments to: Rosemarie Essig |