Enrollment Form
Palace Partners
Name: ______________________________________
Address: ____________________________________
City/State/Zip: _________________________________
Phone: _______________________________________
E-mail: _______________________________________
Age: _________________
Please check all that apply:
( ) I am a friend of a long-term care resident/patient.
( ) I am a family member of a long-term care resident/patient.
( ) I am currently a volunteer in long-term care through a church or civic
organization.
( ) Please call me about volunteer opportunities.
Comments or questions:
Please fill out this form and mail it to the address below. Thank you!
The Palace
P.O. Box 150
Red Boiling Springs, TN 37150
