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By signing in or creating an account, some fields will auto-populate with your information.
  1. Senior Photo
  2. Collinsville Senior Citizens Interest
  3. If you would like to be notified or contacted about upcoming Senior Activities please fill out the contact information below.
  4. Would you like to be contacted about upcoming activities?
  5. Would you consider serving on the Senior Citizens Board of Directors?
  6. What is your age:
  7. Senior activities you would like to have available here in Collinsville (Please check all that are of interest):
  8. ORGANIZED ACTIVITIES
  9. CREATIVE ARTS:
  10. HELP OR ADVICE ON:
  11. LIFE STYLE/MULTISENSORY ACTIVITES
  12. OTHER ACTIVITIES
  13. When would you most likely be able to participate?
  14. Do you have transportation:
  15. Thank you for your input!
    We appreciate you taking the time to sign up and complete the survey. We are excited to have an activity program for seniors in our community.
  16. Leave This Blank:

  17. This field is not part of the form submission.

Contact Us

  1. 106 N 12th Street

  1. P.O. Box 730

  1. Collinsville, OK 74021

  1. Phone: 918-371-1010

  1. Fax: 918-371-1019

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