Family Adult Day Care Registration

Registration Forms

Once you have chosen our center for your loved one's care, you and your loved one's physician will need to complete a number of forms as part of the pre-registration process. For your convenience, we have posted all of the forms right here. After completion, you may drop off the forms at the center, return by mail, or fax them to us at 860-372-4013.

Please be aware that, due to health and safety reasons, physicians forms must be completed and returned to us before attendance at the center. Please feel free to contact us if you have any questions.

Click below to download the forms:


Dale Hume-Rimai, RN, RDH, Director

Family Adult Day Care
445A Willard Ave.
Newington, CT 06111

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Produced by Family Adult Day Care, LLC, 445A Willard Ave., Newington, CT 06111 - 860-436-2013
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