Seniors' Independent Living Application

The Cridge Village Seniors Centre offers 2 meals per day, housekeeping services, recreation programming, and 24-hour security for senior citizens capable of independent living.

This is a smoke-free facility – smoking is not permitted anywhere on the property, inside or out. Unfortunately, we are unable to accommodate pets.

This application must be completed by the applicant(s) and not by a representative. Should the applicant(s) be unable to complete this form on their own, please describe the reason in the Other Comments section.

If the potential resident is unable to complete the application due to computer unfamiliarity, to please print off the form and complete it by hand.

Please note an application does not secure residency; there is an interview and selection process.

Name of an Applicant(Required)
MM slash DD slash YYYY
Name of an Applicant #2 (if applicable)
MM slash DD slash YYYY
Address(Required)
Accommodation required
Vehicle Parking required

Emergency Contacts

Name(Required)
Address(Required)

Family Physician Info

Name
Address