Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Registration Form

  1. Town of North Kingstown

    Department of Senior and Human Services
    P.O. Box 313
    44 Beach Street
    North Kingstown, RI 02852

  2. Expiration Date:

    December 31, 2025

  3. Month Day, Year

  4. Marital Status:*
  5. Gender:*
  6. **Ethnic Background*

    **Ethnic background required by State and Federal Agencies. All information retained as confidential records by Town of North Kingstown Senior and Human Services.

  7. Are you interested in volunteering for Beechwood?
  8. In case of emergency, please notify:
  9. Contact 1
  10. Contact 2
  11. Leave This Blank:

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