FLAMELILY PARK
Flamelily Park together with Victory Park accommodates
some 500 residents.
Accommodation
A Cottage is available at present for short term stays in Durban
for relatives visiting residents.
Rates are R100 per night.
Please contact Zoempie at Flamelily Park on
031 4646421 for further details.
Aerial views of
the Park.
The Frail Care Centre
A Social dance Fathers Day Relaxing Outside
The Frail Care Section of the Park relies heavily on donations
to enable the high level of service to be maintained.
Anyone wishing to make a donation is asked to please contact the web master.
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Flame Lily Residents enjoying a lunch donated by a local bottle store.
Members of Victory Shellhole who helped co-ordinate the event.
"The Grog Shop"...a local bottle store has sponsored this even for the past three years
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FLAME LILY PARK MOTH RETIREMENT VILLAGE DURBAN
Telephone: (031) 4646421 N
ON PROFIT ORGINISATION 565 STELLA ROADFacsimile: (031) 4642524 001-562 NPO QUEENSBURGH 4093 P.O. Box 28323 Malvern 4055 E Mail: flamelilyprk@telkomsa.net
APPLICATION FOR ACCOMMODATION
SURNAME__________________________FIRST NAMES______________________________________________ MALE / FEMALE
DATE OF BIRTH___________________________ I D NUMBER__________________________________________________________
ARE YOU: 1) A MOTH / MOTHWA? YES / NO .. SHELLHOLE________________________DATES____________________
2) A SPOUSE/ RELATIVE OF A MOTH? YES / NO RELATIONSHIP____________________________________
3) ANY MILITARY/ POLICE SERVICE? YES/NO DETAILS ____________________________________________
4) SERVED? RED CROSS / ST JOHN’S / LIONS / SPCA / ETC,___________DETAILS ON BACK OF FORM.
NAMES OF SPOUSE_________________________________________ID NUMBER__________________________________________
PRESENT ADDRESS _____________________________________________________________________________________________
PRESENT TEL.______________________CELL_____________________E MAIL ___________________________________________
ARE YOU LIVING WITH RELATIVES OR FRIENDS? YES / NO
NEXT OF KIN AND RELATIONSHIP_______________________________________________________________________________
TEL_______________________________CELL______________________E MAIL___________________________________________
FINANCIAL
DO YOU OWN A PROPERTY? YES / NO DESCRIPTION_____________________________________________________________
NATURE OF ANY INVESTMENTS_________________________________________________________________________________
ARE YOU CURRENTLY: FULLY EMPLOYED? _______ SEMI RETIRED________FULLY RETIRED__________
TOTAL MONTHLY INCOME IF RETIRED_________________SOURCE__________________________________
HEALTH
CURRENT STATUS: SELF: TOTALLY SELF SUFFICIENT_______SEMI FRAIL________FRAIL_________
SPOUSE: TOTALLY SELF SUFFICIENT_______SEMI FRAIL________FRAIL__________
YOU WILL BE REQUIRED TO SUBMIT TO AN EXAMINATION BY A CERTIFIED MD WHEN YOUR APPLICATION COMES UP FOR IMMEDIATE CONSIDERATION. AT THIS TIME THE ADMISSIONS COMMITTEE WILL DETERMINE THE TYPE OF ACCOMMODATION OFFERED.
ACCOMMODATION IS TAKEN UP ON "YOUR OFFER AND OUR ACCEPTANCE." THE RIGHT TO ANY ACCOMMODATION IS DEPENDANT UPON
THE EVENTUAL COMPLETION OF A MEDICAL EXAMINATION AND FINAL ACCEPTANCE OF THE APPLICANT BY THE MANAGEMENT.
ANY OTHER INFORMATION YOU CARE TO SUPPLY_______________________________________________________________
SIGNATURE_______________________________________________DATE________________________________________________
FOR OFFICE USE ONLY
MEDICAL______________I.S.F._______________I.S.F.B/W_______________ID NO_______________________________________INFO GEN____________________
INFO CLINIC___________________SURETY_________________FRAIL_________________LEASE____________________________STAMPS___________________
FORM DATED 5th.MARCH 2006