Second Orientation – Safety

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To apply for a ramp, please fill out this form. Somebody will contact you with the next steps.

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Name:*

Email:*

Primary Phone Number:*

Secondary Phone Number:

Street Address of the Installation:*

Please note: ramps cannot be installed beyond about an hour's drive from Ridgefield, Connecticut.

City:*

State:*

Can you pick up the ramp sections at Jesse Lee Church?*

yes
no