Village at the Falls. A community of seniors supporting each other as they age in their own homes

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Your Information

First name

Last name

email

Phone

Cell phone

Date of birth

Marital status

Gender

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Address

Number

Street

City

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Zip Code

Available Membership Options

1. FULL MEMBERSHIP, HOUSEHOLD, 495.00 FOR 12 MONTHS, TWO PEOPLE IN THE SAME HOUSEHOLD, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH.: $495.00 for 12 months ($45.00/mo if paid monthly) 2. FULL MEMBERSHIP, INDIVIDUAL, 495.00 FOR 12 MONTHS, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH: $495.00 for 12 months ($45.00/mo if paid monthly) 5. FLEX MEMBERSHIP, HOUSEHOLD, 275.00 FOR 12 MONTHS, TWO PEOPLE IN THE SAME HOUDEHOLD, UNLIMITED SOCIAL ACTIVITIES, UP TO 4 SERVICES PER YEAR.: $275.00 for 12 months ($25.00/mo if paid monthly) 6. FLEX MEMBERSHIP, INDIVIDUAL, 275.00 FOR 12 MONTHS, UNLIMITED SOCIAL ACTIVITIES, UP TO 4 SERVICES PER YEAR: $275.00 for 12 months ($25.00/mo if paid monthly) 9J. FULL MEMBERSHIP, HOUSEHOLD, $247.50 FOR 12 MONTHS, TWO PEOPLE IN THE SAME HOUSEHOLD,UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH (50% SUBSIDY): $247.50 for 12 months 9K. FULL MEMBERSHIP, INDIVIDUAL, $247.50 FOR 12 MONTHS, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH (50% SUBSIDY): $247.50 for 12 months 9H. FULL MEMBERSHIP, HOUSEHOLD, $99 FOR 12 MONTHS, TWO PEOPLE IN THE SAME HOUSEHOLD, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH (80% SUBSIDY): $99.00 for 12 months 9I. FULL MEMBERSHIP, INDIVIDUAL, $99 FOR 12 MONTHS, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH (80% SUBSIDY): $99.00 for 12 months 3. FULL MEMBERSHIP, HOUSEHOLD 45.00 PER MONTH, TWO PEOPLE IN THE SAME HOUSEHOLD, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH: for 12 months ($45.00/mo if paid monthly) 4. FULL MEMBERSHIP, INDIVIDUAL, 45.00 PER MONTH, UNLIMITED SOCIAL ACTIVITIES, UP TO 12 SERVICES PER MONTH: $45.00 per month for 12 months 7. FLEX MEMBERSHIP, HOUSEHOLD, 25.00 PER MONTH, TWO PEOPLE IN SAME HOUSEHOLD, UNLIMITED SOCIAL ACTIVITIES, UP TO 4 SERVICES PER YEAR.: for 12 months ($25.00/mo if paid monthly) 8. FLEX MEMBERSHIP, INDIVIDUAL, 25.00 PER MONTH, UNLIMITED SOCIAL ACTIVITIES, UP TO 4 SERVICES A YEAR.: for 12 months ($25.00/mo if paid monthly)

Additional Information

First Emergency Contact

First emergency contact name

First emergency contact relationship

First emergency contact cell phone

First emergency contact phone

First emergency contact email

First emergency contact address

Current Health

Mobility issues

Home type

Employment status

How long have you lived in the city

Your interests what do you love doing

How did you hear about us

What made you interested in becoming a member?

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Membership inquiry form