TOWN OF PUTNAM
COMMISSION ON AGING
COMMUNITY ROOM SURVEY
We are looking forward to the opening of the Putnam Community Room at the new Municipal Complex.  We are asking Putnam’s Senior Citizens to help us determine what programs you would like to see offered.
Please fill out the survey and return to either – Office at your housing complex, drop off at Putnam Recreation Dept. on 126 Church St. (2nd Floor Town Hall), or Mail to: Putnam Recreation Dept., 126 Church St., Putnam, CT  06260.
1) We will be offering a TVCCA Lunch program Mon.-Fri.
at the Community Room.  Does this interest you?   Yes_____  No _____
2) We are exploring the availability for Transportation for daytime programs and lunch program. Does this interest you?  Yes _____  No _____
3) We are exploring various programs from 9:00 am-1:00 pm
at the Community Room. Does this interest you?  Yes _____  No _____
Please check off programs you would like to see offered:
     Exercise for Seniors _____  Games (cards, Bingo, board games,
      etc.) _____  Educational Programs for Seniors _____
      Book Discussions _____    Movies/Guest Speakers _____
     Health Programs ________   
4) We would like to hear any suggestions you have
      for activities/programs. (write here):
________________________________________________
5) Would you be interested in volunteering at the Community Room?              
Yes _____  No _____
Optional: (If you answered Yes to question 5),
NAME:      ______________________________
PHONE:    __________________________


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