• In creating an account for this program, I understand that payments will be withdrawn every week. If the participant chooses to terminate their participation in the program, they may do so at any time with the understanding that the cancellation will take effect starting when the next payment was due. There are no refunds for payments already made.
• I agree that Age Well Senior Services may collect the information necessary to administer this program. The participant(s) agrees to release their name, address, phone, and email to complete the appropriate referral to obtain restaurant meals. The participant(s) also understand that they may receive materials from Age Well Senior Services as part of their participation in this program.
• Under penalty of perjury, I hereby attest that the all participants signed up for this program are 50 years of age or older (or a dependent or caretaker of someone 50 years of age or older) and that all information entered in this application is true.
• I have read and agree to the Terms of Use of this program.

If you are having any trouble with this form, please contact our Customer Service line at 949-382-6099.