Sign up with our Elderly Program

Hmong people value our old people--whether they are our grandparents or some strangers on the street. Our Elderly Program is a safe place where Hmong O.G.s can hang out, make new friends, and get away from the drama of their crazy kids and grandkids.

Please complete the form below

Name

First Name

Last Name

Phone

(###)

###

####

Address

Where would you like your Elder to be picked up at

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

We understand that not all Elders have an email account but the responsible party must.

Why would you like to join?

Ailments

Please check the concerns you have for your Elder.

Prescribed Medication

Self-prescribed Medication

Herbal Tea

Dementia

Old Age

Wheelchair Accessibility

Allergies

Other, will be included below

Other concerns or comments

ELDERLY PROGRAM

Sign up with our Elderly Program

Please complete the form below

HO is a mockumentary comedy web series about the daily lives of a Hmong nonprofit