Caregiver Access Card Request Form

Caregiver Access Card Request Form
Will a member of your household be visiting one of our amenities with a caregiver? Windsong Ranch residents may request an access card for caregivers (limit two per home, $25 per card). Please provide your caregiver information where indicated below. Processing time is generally 1-2 days, and you will receive confirmation and an invitation to pick up your caregiver access card when done.

To request an access card for a resident, click here.
Caregiver Name*

First NameLast Name
Windsong Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Caregiver Email*
example@example.com
Caregiver Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Caregiver Date of Birth*

MonthDayYear
Date of Birth

Access Card Photo

In order to print your access card, the photo must meet the following criteria: Your head must face the camera directly with full face in view. You must not be wearing any hats or sunglasses or any items that cover your face. The photo must have been taken in the last 6 months.
Upload photo of Caregiver*

Cancelof

Access Card Payment / Replacement Policy

Each caregiver card will be $25 each. If I misplace my card, I will have to pay the $25 replacement fee.
I have read and understand the statement above.

Caregiver Addendum

The Caregiver Agreement MUST be completed by the homeowner before the access card can be picked up. The caregiver addendum will be sent to your email with the confirmation that we received your access card request.
I have read and understood the statement above.

Facilities Use Agreement

The Facilities Use Agreement must be completed by the caregiver before the access card can be picked up. Once you click submit below, you will automatically be redirected to a page to fill out the waiver. If they are not currently with you, you can send them the form using this link: https://waiver.smartwaiver.com/w/5cdf36f52b8fc/web/
I have read and understand the statement above.
Should be Empty:

Access Card Photo