Membership Information Request

JOIN THE VILLAGE

Kingdom Care Senior Village (KCSV) works to support senior adults, aged 60 and older with a network of services and a wide-range social/cultural events to help them remain comfortable and safe in their homes.

All full members of KCSV are eligible to receive many benefits, services, and participate in events with little to no cost.

Your Information

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Ethnicity

Address

Number

Street

City

State

Zip Code

Available Membership Options

Household: $360.00 for 12 months ($30.00/mo if paid monthly) Individual: $240.00 for 12 months ($20.00/mo if paid monthly) Individual - Reduced Fee: $120.00 for 12 months ($10.00/mo if paid monthly) Honorary - 92 Years/Older: $0.00 for 12 months

Additional Information

Current Health

Mobility issues

Employment status

How did you hear about us

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Thank you for your interest

Thank you for contacting us — it’s a pleasure to connect! Our team is committed to providing friendly, professional assistance, and we’ll be reviewing your message right away. You’ll hear back from us soon.