Lake Jennings UAT - New Customer

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Senior Center Membership Request

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Select Preferred Center :

Eligibility:

To qualify for membership at Neighborhood & Community Services (NCS) Senior Centers, a participant must be 50 years of age or older and

with or without a reasonable modification be:

• Able to orient correctly to person, place and time
• Able to independently navigate to programs and through center facilities safely
• Able to get on and off a county vehicle safely
• Able to remain seated in a county vehicle with the seat belt fastened until the vehicle comes to a complete stop
• Able to receive and follow instructions independently
• Able to recognize and respond appropriately to emergency warnings
• Able to adhere to the Senior Center’s Terms of Membership/Code of Conduct when participating in programs, taking advantage of services or otherwise using the facilities
• Able to maintain personal care (eating, restroom usage, personal hygiene, medication management) independently

I have read, and understand the

Eligibility of Membership.

If I no longer meet one or more of the Eligibility Requirements, an evaluation by trained staff will be utilized to determine my functional level and appropriateness of my continued participation. NCS will assist and refer prospective and current members to appropriate resources and transition them to other supportive services in their best interest and safety.

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Senior Center Membership Request

(*)

Select Preferred Center :

Eligibility:

with or without a reasonable modification be:

Eligibility of Membership.