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Prefer to mail in your application?

Simply print the application below and mail it to:

SHARE, 104 Cottage Pl., Ridgewood, NJ 07450

Print Application

Thank you for your interest in SHARE, INC. If you have not already visited us,
please call the Executive Director at 201-670-9605 soon to arrange a visit
and discuss SHARE Senior Residences waiting list status.

Confidential Online Application

Please fill out the information below and we will be in touch!

Online Application

First Name *

Last Name *

Address *

City *

State *

Zip

Phone

Birthday

Marital Status

Your Age

Gender

Male
Female

Place of Birth

Housing: Current Living Arrangements

Alone
With Others

What are your current monthly housing expenses? *

Residence History

Have you ever owned your own home?

If yes, what year did you sell?

Date you wish to move in:

Multiple Choice

First Choice
Second Choice
Third Choice

Primary Physician's Name: *

Address of Physician:

City

State

Zip

Physician Phone Number

We do require full disclosure of past medical history - Please tell us about your medical history and medications:

Please be aware that a resident who becomes unable or unwilling to self-medicate will no longer be considered eligible for residency.

What kinds of hospitalizations have you had during your lifetime:

Have you been admitted to a hospital within the last year?

If yes, for what reason and what hospital:

Have you ever been admitted to a rehabilitation facility?

Are you currently or have you ever been under the care of a psychologist/psychiatrist/therapist?

If so, describe:

Are you currently a smoker? Smoking is not allowed in either residence nor anywhere on the premises.

Family member first name

Family member last name

Family member address

City

State

Zip

Family member phone

Family member email

Has anyone been appointed power of attorney or guardian? *

If yes, please name

Relationship to you:

POA Address

POA Phone

To what extent?

Legal/Financial
Medical
Both
Other

Name of person financially responsible to SHARE INC., if other than yourself.

Relationship to you:

Address

Cell Phone:

Home Phone

Business Phone

Why have you chosen to seek residency at a shared house?

How did you hear about our houses?

Do you have any special hobbies, interests, or vocation? Please describe:

At present, how do you usually spend your day?

Our residents have meals together and occasionally participate in some group activities. Much time is spent alone, however, doing what each person enjoys.

Are you bringing a car?

Parking is subject to availability and subject to the discretion of the Board of Directors.

How do you feel about the participation described below? *

Weekly housekeeping is professionally done. However, our residents do have a SHARING SCHEDULE at meal time: In teams of two, one day a week, they set/clear the dining tables, load the dishwasher, and wipe off the tables.

How do you feel about this? *

Two people share a bathroom at all times, during your residency with us you may be required to share a bathroom with a person of the opposite sex.

How do you feel about the below participation?

Meetings with residents are held once a month to exchange ideas and suggestions.

Is there anything we have not covered that you would like us to know about you or your housing requirements? Please specify:

Contact us

Send us a message and we will reach out to you as soon as possible.

Send Message

Questions? Send us an email

Contact Us

SHARE, Inc.
104 Cottage Place
Ridgewood, NJ 07450

Email: [email protected]
Phone: 201-670-9605
Fax: 201-251-6412

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About SHARE Inc.

Our all-volunteer Board of Trustees and Directors works to ensure the fulfillment of SHARE’s mission: to provide an affordable, home like environment for independent seniors age 55+ in Bergen County.

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