Presbyterian Homes & Services housing and services for older adults

RESERVATION FORM

Charter Member

Contact Name
Home Phone
Work Phone
Street Address
City
State
Zip
Email Address
Relationship to prospective resident:
	self adult child other relative friend professional (please specify)

Prospective Resident Name
Street Address
City
State
Zip
Home Phone
Cell Phone
Email Address
Add'l Contact Info.

Desired Housing and Accommodations (Check living option and designate 1st and 2nd size choice)
*Living Options:*	*Size: (enter 1 for first choice and 2 for second choice)*
Mews	2 Bedroom 1 Bedroom 1 Bedroom/Den First Available
Assisted Living	2 Bedroom 1 Bedroom 1 Bedroom/Den Studio First Available
Caring Companion- Memory Care (IL)	1 Bedroom Studio First Available
Care Center	1 Bedroom

Call Marlene at 651-765-4018 to
learn more about and to become
part of this Nothing Less Than
Exceptional senior living

Waverly Gardens
5919 Centerville Road, North Oaks, MN 55127
651-765-4000 • www.waverlygardensphs.org