Registration 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 Tuesday only Thursday only 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 Agree to Terms & Conditions(required) Yes No Other request(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 