Registration Respite Participant Information —————————————————————– First Name(required) Last Name(required) Profession Address (only for new participants) Town Zip DOB(required) Contact Email(required) Contact Phone Medical Conditions we need to know, swallowing difficulties, incontinence…(required) Day(s):(required) Tue & Th M, W, F M-F Another Walking:(required) No Assistance Walker Cane Other Diet:(required) None Vegetarian Diabetic Other Vaccines:(required) COVID19 x 2 Current Flu Other * Member of Oasis? Yes No I wish to be a member Agree to Terms & Conditions(required) Yes No Do you need overnight respite stays? Other requests (s), special needs etc… Send —————————————————————————————————– Membership entitles registrant to some additional benefits. Please keep in mind that this is a non-medical facility. If your love one needs care, assistance needs to be provided. Terms and Conditions Δ Like this:Like Loading...
OASIS WeCare 