Application Form

Please use the form below to apply online. A copy of your application will be forwarded to you if you choose to enter your email at the bottom.

If you would prefer to print and mail your application please use the appropriate application form (Pineview Manor Application | Country Garden Application) and submit completed application to:

Mennonite Nursing Home
Box 370
Rosthern, Saskatchewan
S0K 3R0

Online Application

Pineview ManorCountry Gardens

 

Small SuiteLarge SuiteBoth

 

 

MaleFemale

 

Length of stay at your current residence:

 

YesNo

 

Occupant #1
Occupant #2

 

MaleFemale
MaleFemale

 

Length of Stay:
Length of Stay:

 

 

YesNo
YesNo

 

 

 


YesNo

 

I hereby declare that I have completed this application form to the best of my knowledge. If accepted I will abide by the rules and regulations as set by the Board of Directors or Management. I also recognize that the Board of Directors will not be responsible in any way for any debts which I may incur.