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Forms

Where available, you can submit a form by entering information in the appropriate text fields and clicking the Submit button,  or you can download forms and fill them out when it's convenient for you. Many of the forms still require your signature; please either mail or deliver these to our offices.

Please note, most Dutchess County forms are available as PDF documents. This format requires that you have Adobe Acrobat Reader installed on your PC. Click on the Adobe Acrobat Reader icon Adobe Acrobat icon to download a free copy of this software.

View All Dutchess County Forms (A - Z)

All Forms


A Matter of Balance: Managing Concerns about Falls - Participant Application (.pdf)

A Matter of Balance is a community class specifically designed to reduce fear of falling, stop the fear-of-falling cycle, and improve activity levels among community-dwelling older adults. The program includes eight two-hour classes presented by trained coaches using an extensively detailed training manual and two instructional videos.  To enroll in the class, complete the A Matter of Balance application:  Managing Concerns about Falls Participant Application (.pdf)



Bingocize Application (.pdf)

Bingocize is an evidenced based program created by Western Kentucky University to provide a stimulating and fun way to improve your physical and mental health as well as learning helpful falls prevention tips. It is a strategic combination of exercise and bingo with some important health information presented during the game. You attend two sessions per week for 10 weeks. Each session is led by a trained facilitator and takes about 45 minutes to an hour to complete - but it goes by fast, because you are having so much fun playing Bingo and winning prizes.

Required:

  • A doctor’s note
  • A completed Bingocize application (.pdf) This form can also be obtained from the leader when the class begins, if you have not submitted one to the Office for the Aging with your completed application. 


OFA Exercise Program Application (.pdf)

This exercise program is a progressive weight training and balance improvement program designed for older adults

Required: 

  • Complete the OFA Exercise Program Application (pdf)
  • A suggested donation for this program is $25 per year, and can be mailed in with your application. Checks should be made out to DCOFA Senior Exercise Program.
  • Return to: 
    Dutchess County Office for the Aging
    114 Delafield Street, Poughkeepsie, NY   12601


Tai Chi Application (.pdf)

OFA Tai Chi classes are conducted by certified instructors and are open to any suitable person as specified below, provided they are medically fit to attend the class. This can be in the form of a prescription or doctor’s/healthcare provider’s note. Participants must present this at the first class. In terms of physical exertion, the Tai Chi exercises in this class would be similar to walking. Tai Chi classes usually last for one hour. Classes are one hour in length, with periods of rest as needed. In terms of physical exertion, the Tai Chi exercises in this class would be similar to walking. Participants will be encouraged to work within their own comfort zones at all times. They will perform gentle warm up exercises at the beginning of the class and cool-down exercises at the end.

Required:

  • A medical clearance from their doctor prior to beginning the class.
  • Participants must be 60 years or older
  • Interested in improving balance, strength and endurance
  • Able to exercise in a standing position
  • Complete the Tai Chi registration form (.pdf) and return to Dutchess County Office for the Aging


Volunteer Registration Form

Office for the Aging volunteers are needed for a variety of purposes:

  • to deliver meals to homebound older adults throughout Dutchess County
  • to lead classes in our OFA Exercise, Tai Chi, Bingocize and "A Matter of Balance" programs
  • to assist older adults at OFA outdoor events, mainly in the spring, summer and fall
  • to assist with clerical work at OFA headquarters in Poughkeepsie
  • to serve as trained counselors in our Health Insurance Information, Counseling and Assistance Program (HIICAP)
  • to assist at OFA Friendship Centers throughout the county. (Click here for a list of Friendship Centers)
  • to assist older adults in adapting to new technology

Whether you can volunteer every day or only once in a while, OFA has a volunteer opportunity for you.

Required: 

  • Complete the Volunteer Registration Form (.pdf)
  • Volunteers under age 18 must have a parent or guardian complete and return a release (.pdf)
  • Return to: 
    Dutchess County Office For the Aging
    114 Delafield Street, Poughkeepsie NY   12601