Application form for individual web page on this web site 2010

Personal care homes in Regina and area can now have a solid presence on the web. The average consumer who might be assisting their family member to find a care home will be able to easily find information from our site.

If you are a member of our association in 2010 you will be listed FREE on both the association's main listings page and the vacancy page. 

In addition to this FREE listing you may acquire an EXPANDED listing for a onetime set up fee of $50. Your business name will be linked from the main page and the vacancy page to YOUR page.Fill in the form attached and return it to Denise Needham Box 369 Regina Beach S0G 4C0 along with a check for $50, 1-3 photos and a self addressed stamped envelope so I can return your photos to you along with a receipt. Make check payable to 'Two Spirit Country Care Home".

Please print legibly.

Name of care home:____________________________________________________

Names of owners:______________________________________________________

Address:______________________________________________________________

Postal Code:______________________

Telephone:________________________

Cell:_____________________________

Fax:_______________________________

Email:_________________________________________________________________

Web address:____________________________________________________________

Area: circle Northwest north southeast southwest north/central south/central other______________________________________________

Average fees: $__________________(or a range) or from__________________

Wheelchair accessible : yes no

Capacity: ______ beds

Gender: M F both

Night staff: 24 hour supervision yes awake

Smoking: yes no

Special care: list any special care you provide in your description: These could include any of the following:

Catheter care.Dementia care,Alzheimer's care,Wound care,Ostomy Care,Diabetic care,Oxygen Therapy,Special diets, Renal dialysis care,Physiotherapy program supervision,occupational therapy program supervision

Respite: yes no

Oxygen: yes no

Levels of care: circle 1 2 3 4

Pets: yes no list____________________________________________

Sprinkler system: yes no

Call system: yes no

Monitor: yes no

Door alarms: yes no

Vacancies: ________________________________________

Description:_______________________________________________________________________________
________________________________________________________________________________________
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Notes: In the description describe your home and 'sell' yourself. What do you offer? Here is an example.

Our home is tastefully decorated with all private rooms, central air, fireplace, games room. Our yard is landscaped with deck, shaded seating area. Our goal is to provide a helping hand to individuals who require palliative care …………………………………………………………………………….. use up to 70 words in this section and use more paper if required.

Photos: Send in up to 3. Mail me originals that are clear, bright and focussed. Shots of smiling people in comfy chairs work well. I will scan them. Ask for permission from any people you have in your photos. A picture of the front of your house is good. You could email jpgs if you have them.

Vacancies: You can phone me with your vacancies when you have them and call me back when they are filled. I will edit those as needed.

Choose a 'one word name' to define your page. Kelsey Manor could be 'kelsey'. Helping Hand Personal care home could be 'helping' or 'hhpch'. This name will be attached the web site name. Example: www.carehomes.ca/kelsey

Once this page is listed you may use this name on your business cards or you may direct inquiries to look at your personal page.

My one word name choice is _________________________________________

Any questions or comments? Please call me at 731 2200

If you want to fax me call me first so I can plug in the machine.

Denise Needham