CommForms - Congregate Dining

CommForms - Congregate Dining

Note this website is for demonstration purposes only and no actual services will be ordered.

To see the form in action fill in the service request and click send.

Please enter a valid email address so that you can receive a copy of the email confirmation.

We will also send you a copy of the service notification your office staff would receive.

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Are you a current client? *

First name *

Last name *

Telephone Number *

Email address *

(Used to send a confirmation email)

Please select the diners club you would like to attend and make sure to select the date you would like to attend by clicking on the calendar. Dates in which service is not available are marked on the calendar in red *

Brunch Club Every Tuesday

Enjoy a nutritional well-balanced meal, with social and recreational activities in a friendly environment

Lunch Club every Thursday

Enjoy a nutritional well-balanced meal, with social and recreational activities in a friendly environment

Message:

Please check each box below to confirm the following:

Please leave this field empty

I have reviewed the cancellation policy (click here to review). *

I have reviewed the privacy consent policy (click here to review). *

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Once your Diners Club request has been sent, a Community Support Services Coordinator will contact you within 1 business day to confirm if we can accommodate your service request.