City of Refuge Ministries

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Senior Survey

This survey is designed to gather your opinions regarding Senior concerns. City of Refuge Ministries wants to know what areas you would like more information in so that we can be a support and blessing to you.

First Name

Last Name

Would you benefit from technological assistance in the areas of social media, computer skills, and assessing information on our apps?
Yes
No

What services would you like access to? This could include but not limited to: grocery drop off or pick up, medicine pickup, transportation needs, etc.

Are you interested in learning about places you can exercise, or access to other exercise opportunities? This could include: internet channels that offer exercise or a zoom call with someone leading you in exercises.
Yes
No

What medical needs would you like assistance with? This could include, but not limited to: medication needs, health care information from your medical team, medicare or life insurance information.

What are some social activities you would enjoy doing with other church members? (covid protocols in place)

When you are ill, what type of contact would you prefer from the church?
Phone calls
Cards
Flowers
socially distanced visit from Pastors & Elders

Would you like a Senior Counseling group, similar to "We Care?" This group would meet once a month to discuss feelings of isolation, needing emotional support, and other encouragement.
Yes
No

Would you like a "Kicking it with the Seniors" night with old school music, games, and prizes?
Yes
No

What are your thoughts about having staff that you can contact in case of emergencies that you can talk with and receive support?

What other concerns would you like to see addressed by the church?

Submit

City of Refuge Ministries
401 E Jefferson St. Bloomington, IL 61701
309-827-4223