Self Contained Programs

Please number in order of preference which building you would like to be placed*
Barrett Kiwanis Place Canyon View Kiwanis Place Centennial Kiwanis Courts
Please number in order of preference which building you would like to be placed*
Fleming Kiwanis Manor Crimson Villas Waskasoo Kiwanis Towers
*Please note that all buildings are moving towards a Smoke Free policy*
Please note any special requests (Main floor, upper floor, wheelchair accessible suite):*
*Please note that the Bridges Community Living will do our best to accommodate you in your building of choice, however, please be advised that being too selective may increase your wait time.
Do you have a motorized mobility aid*
- Scooter
- Motorized wheelchair
- No
Other
Weight of aid
Length of aid
Width of aid
Weight of aid*
Length of aid*
Width of aid*
Liability insurance*
- Yes
- No
Parking
Automotive parking spaces with the Bridges Community Living are very limited and are issued on a first come first serve basis. Parking spaces will only be given to tenants with their own vehicles. Do you want to add your name to the parking waiting list?*
- Yes
- No
Have you rented accommodations from Bridges Community Living or Twilight Homes in the past?*
- Yes
- No

DECLARATION
Dominion of Canada} In the matter of application for accommodation with the Piper Creek Foundation}
I,*
of the City*
in the province of Alberta, do solemnly declare as follows:

1. That I am the applicant named in this application;

2. That the statements made by me in this application are to the best of my knowledge, information and belief, full and true in all respects and authorize the Piper Creek Foundation or its agents permission to investigate any or all of the statements made by me in this application;

And I make this solemn declaration conscientiously believing it to be true and knowing that is of the same force and effect as if made under oath and by virtue of the "Canada Evidence Act".
Declared before me at the City of*
In the province of Alberta, this*
Signature of Applicant*
A Commissioner for Oaths in and for the Province of Alberta
Printed name of Commissioner for Oaths
Appointment expiry date
CAPTCHA

If a translator is required, please provide their contact information