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Senior care package request form
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Request a Senior Care Package
These care packages are intended for Northern Berkshire seniors 60+ who are housebound and/or have difficulty leaving home due to health restrictions. Towns eligible for delivery at this time are: Adams, North Adams, Williamstown and Clarksburg. (Rural areas in these towns may not be eligible to receive delivery, but pick up is available by emailing director@berkshirehelpinghands.org to make arrangements.
Name of Senior
*
First
Last
Phone Number
*
Address
*
Town
Adams
Clarksburg
North Adams
Williamsburg
Email
Age
*
Relationship to Senior
Self
Relative
Other
Name of Requestor
*
First
Last
Phone Number of Requestor
*
Describe Your Relationship to Senior
Delivery Instructions
Color of House
Special Instructions
Submit