The Assisted Living Centre Application Form :: Luther Village on the Park

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The Assisted Living Centre Application Form

To indicate your interest in a Assisted Living Centre unit, please complete this online form and mail a refundable $500.00 deposit. The order in which these forms are received will be the order in which interested people will be given the opportunity to choose their particular unit.

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Please complete this online form and mail a $500.00 deposit cheque payable to Lutherwood.
(Please note: this deposit is fully refundable should you decide not to rent).

Name*

Street Address*

City*

Province*

Postal Code*

Phone Number*

E-mail Address*

Age(s)

Congregation

Would you like to be on our mailing list?*

I/We are interested in:

Studio 1 Bedroom 2 Bedroom

Suite # preference (if known) Style:

Services required:

Please complete this online form and mail a $500.00 deposit cheque payable to Lutherwood.

Luther Village on the Park
139 Father David Bauer Drive
Waterloo, Ontario
N2L 6L1
Phone: 519-747-4413

Luther Village On The Park

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The Assisted Living Centre Application Form

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