Name *

First Name

Last Name

Address *

Please note: This box is available to NW Goldberg residents only.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Do you currently have Wi-fi in your house or apartment? *

Yes

No

Are you aware that HFHS's ArtBlock is available to rent for free for community groups and non-profits? *

Yes

No

What programs would you like to see at ArtBlock in 2022? *

Healthy eating and cooking

Senior healthy lifestyles

Pre-diabetes and diabetes education

Vaccine clinics

Art and music therapy

Would you like to receive information on NW Goldberg Cares' free youth sports and literacy summer programs? *

Yes

No

Do you currently own or work for a small business that would be interested in opening a location or moving to the NW Goldberg neighborhood? *

Yes

No