Seniors

Join TEL HI's Senior Program Today!

We’re excited to welcome you to TEL HI’s vibrant Senior & Adult Community! Registering is simple and convenient, with two easy options to get started:

Option 1: In-Person Registration

1. Download the Senior Program Registration Form: Click here to download..
2. Print and complete the form.
3. Deliver the form to Koletti Leha Ieremia, TEL HI’s Senior Program Manager, at: 555 Chestnut Street, San Francisco, CA 94133.
   Her office is conveniently located at the top of the stairs.

Option 2: Online Registration

1. Complete & submit the online registration form below
2. Submit the Senior Program Agreement Form: Download the Form here.To finalize your registration, the Senior Program Agreement Form must be signed. You have two ways to submit it:
   • Email it to Koletti Leha Ieremia at KLeha@telhi.org.
   • Print it and return it to Koletti’s office at the address above.

   Senior & Adult Program Registration Form

   To enroll int TEL HI's Senior & Adult Program, please fill out and submit this form. Someone from TEL HI will be in touch with you shortly. Thank you!

   Name(Required)

   First Name/ 家长名字 Last Name/ 家长姓氏

   Official Name (If Different From Above)

   Age

   Date of Birth(Required)

   MM slash DD slash YYYY

   Email / 电子邮箱

   Enter Email Confirm Email

   Home Phone Number/ 联系号码

   Cell Phone Number/ 联系号码

   Address

   Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

   Emergency Contact Information(Required)

   Incase of an emergency who should we notify?

   Name (First & Last) Relationship to You Emergency Contact Phone Number

   Race/Ethnicity

   The information below is confidential and used for data collection only

   American Indian/ Alaska Native

   Black or African American

   Chinese

   Filipino

   South Asian

   Other Asian

   European

   Hispanic/Latino

   Middle Eastern

   Native Hawaiian/ Other Pacific Islander

   White

   Multiracial/Multiethnic

   Other

   Home Language

   The information below is confidential and used for data collection only

   English

   Cantonese

   Mandarin

   Spanish

   Tagalog

   Other

   English Fluency

   The information below is confidential and used for data collection only:

   Fluent

   Somewhat Fluent

   Not Fluent

   Annual Household Income

   The information below is confidential and used for data collection only:

   Under $20,000

   $20,001-$40,000

   $40,001-$60,000

   $60,001-$80,000

   $80,001-$100,000

   Over $100,001

   I am interested in learning more about (click all that apply)

   Lunch/Meal Program

   Senior & Adult Resources

   Senior Advisory Board

   Exercise Classes

   Recreational Activities

   Volunteering

   Other

   Please list any current medications, medical conditions, recent injuries, and food or drug allergies:

   How did you hear about TEL HI's Program?

   Word of mouthInternet SearchSocial MediaCommunity eventOrganization ReferalOther

   Comments / 評論

   Please let us know what is on your mind. Have a question for us? Ask away!

If you have any questions or need assistance, please don’t hesitate to contact Koletti Leha Ieremia at KLeha@telhi.org or call us at (415) 580-7234.

We can’t wait for you to join TEL HI’s Senior Program community!

Support TEL HI’s Senior Program

TEL HI’s Senior Program depends on the generous support of donors like you to continue providing these vital services and activities to our senior community. Your contribution helps us keep our programs accessible, enriching, and impactful.