Big Bingo

Clayton CSA x Oak Street is excited to host Big Bingo exclusively for residents aged 55 years and older! This special event is designed to promote health and wellness, offering valuable resources to help minimize the risk of long-term health issues.

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* 1. Name

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* 2. Email

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* 3. Phone (optional)

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* 4. Date of Birth

Date / Time

Date

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* 5. Do you follow any of the these dietary restrictions? (Please select all that apply.)

Vegan

Vegetarian

Religious Dietary Restrictions (e.g., Kosher, Halal)

Lactose Free

Weight Loss Diet (e.g. Keto, Low Sugar, Weight Watchers)

Low Salt

Food Allergy (e.g. gluten free, peanut free)

Intermittent Fasting

I do not follow any of these dietary restrictions

Prefer not to answer

Other (please specify)

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* 6. Are you currently an Oak Street patient?

Yes

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* 7. Have you ever attended a Clayton CSA (1000 Main Street) event before?

Yes

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* 8. May we contact you for future events?

Yes