Classroom Heroes Request Form

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First Name *
Last Name *
Home Address *
City, State, Zipcode *
Email *
Phone *
Are you married? * Yes No
If yes, what is your spouse’s name?
Best time of day to reach me by phone * Morning Afternoon Evening Anytime
Name of school where I work *
My Title *
I have previously completed and signed a Living Will/Health Care Power of Attorney. * Yes No
(Optional) For the following reasons, I feel particular urgency to complete a Pennsylvania Living Will/Health Care Power of Attorney
You are participating in a complimentary referral service coordinated by the Lancaster Bar Association (LBA) and the Lancaster Law Foundation (LLF). The LBA will refer your request to a licensed attorney who has volunteered to offer a free Living Will/Health Care Power of Attorney. The LBA does not supervise or control the advice or services rendered by its members and, therefore, does not make any representations or warranties as to such advice or services.