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Shrewsbury Senior Center Facility Use & Program Application

  1. Use Type (Check One)*
  2. Program Type:
  3. Are you a Shrewsbury Resident?
  4. Program Level (if applicable)
  5. *6 Month Maximum
  6. Please check requested day(s)*
    Shrewsbury Senior Center hours M-F 8AM-4:30PM
  7. FOR INSTRUCTORS ONLY
  8. Will you be charging for materials?
  9. Will you be asking for donations or receiving participant incentive pay from the COA?
    *As of May 1, 2021 Participant Incentive Pay is $5 per class/activity participant. This is for instructional programming only and does not apply to clubs.
  10. Do you have any certifications?
  11. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) you have read the Shrewsbury Senior Center Policies and Procedures and Council on Aging FY21 COVID-19 Operations plan and agree to comply with the conditions. Documents can be found here: https://shrewsburyma.gov/1016/Documents-and-Forms
  12. Please list your email address
  13. Leave This Blank:

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