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.