Senior OnePass Renewals (born 1960 or before)

Household ID: (as printed on OnePass) *

Senior First Name *

Senior Last Name *

Senior Birthday *

Household Email *

Select Additional Senior ONLY Family Member/s (born 1960 or before)

Not Applicable for Guests

Only type the names and date of birth for the additional seniors if your are not signed into your account, and have not selected the names above.

** Do NOT add family members who are not currently in your account. **

Second Additional Household Senior Name and birth date (required)

Third Additional Household Senior Name and birth date (required)

Check the box to request the Department of Parks and Recreation search Town records it may have on file in order to verify my residency, and the residency of other members in my household aged 65 years and over.

I understand if an exact match is not found the department will request further document verification.

If you do not check the box above, please upload residency documents for each senior family member below.

Document Upload: Residency Proof Document

Document Upload: Residency Proof Document (additional)

Document Upload: Residency Proof Document (additional 2)

Document Upload: Residency Proof Document (additional 3)

Sign here - type your name and then sign below. *

Submit