2. Age/Birthdate*
3. Street Address (optional)
5. Do you believe that senior and disabled programs and services are essential for improved quality of life?*
   -- Select One --YESNO
7. Do you believe that a dedicated senior center building is essential for providing senior and disabled programs and support services?*
   -- Select One --YESNO
9. Are you aware that there are two one-day per week senior centers in El Cerrito currently operating in partnership with West Contra Costa Older Adult Education at Christ Lutheran Church, 780 Ashbury Ave on Mondays from 9am-3pm and St. John's Church, 6500 Gladys Ave on Tuesdays from 9am-3pm?*
   -- Select One --YESNO
11. Are you aware that the City of El Cerrito Recreation Department currently offers several classes, programs, and support services for seniors at the El Cerrito Community Center, 7007 Moeser Lane?*
    -- Select One --YESNO
13. Are you currently participating in a senior class/program or receiving support services in El Cerrito? If yes, where do you take the class/program/receive the support service?*

    1. Christ Lutheran Senior Center, 780 Ashbury Ave
    2. St. John's Senior Center, 6500 Gladys Ave
    3. El Cerrito Community Center, 7007 Moeser Lane
    4. El Cerrito Library, 6510 Stockton Ave
    5. Sakura Kai Senior Center, 5625 Sutter Ave, Richomnd
    6. West Contra Costa Adult Education, Alvarado Campus, 5625 Sutter Ave, Richmond
    7. Other
    8. I do not currently participate in senior class/programs or receive support services
15. If other, where?
17. Are you or is someone you know in need of and not currently receiving senior support services in El Cerrito?*
    -- Select One --YESNO
19. What senior class(s)/program(s)/support service(s) do you most want to see offered in El Cerrito? Check all that apply*

    1. Lunch program
    2. Exercise & Fitness classes
    3. Enrichment classes (art, languages, music, games, etc.)
    4. Day Trips & Excursions (museums, hiking trails, bird watching, restaurants, etc.)
    5. Informational Presentations & Class Demonstrations (Free)
    6. Technology Presentations & Tutoring
    7. Support Groups & Services
    8. Senior Transportation & Travel Training
    9. Other
21. If other, what senior class(s)/program(s)/support service(s) would you like to see?
23. How do you find out about senior programs and services that are available in El Cerrito? Check all that apply

    1. West Contra Costa Adult School brochure
    2. West Contra Costa Adult School website
    3. Library
    4. Recreation Department rEC Guide
    5. 60+ Bulletin (monthly)
    6. El Cerrito Committee on Aging Outreach Newsletter (bi-monthly)
    7. City website: www.el-cerrito.org/recreation
    8. E-newsletters (City Manager update, rEC news)
    9. Social Media (Facebook, Instagram)
    10. Flyer or Poster
    11. Friend or relative
    12. Other
25. If other, where?
27. Do you or does someone you know need assistance getting information about senior programs and services in El Cerrito?*
    -- Select One --YESNO
29. If yes, what is your preferred method for receiving information?*

    1. Email
    2. Mail
    3. Other
31. If other, how do you prefer to receive information?
33. Do you have any additional information you would like to share with us regarding senior classes/programs and support services in El Cerrito?
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field