Rappahannock Club Registration

Rappahannock Club Registration

RWC’s priority reservation program, The Rappahannock Club, serves as a short-term waiting list for residences that are currently unavailable. Membership also provides priority status for those who are planning ahead but are not yet ready to move. A completed registration form and a fully refundable $1,000 deposit are required to join.
Name 1

PrefixFirst NameLast Name
Name 2

PrefixFirst NameLast Name
Date of Birth 1st Person

MonthDayYear
Date of Birth 2nd Person

MonthDayYear
Relationship (if two or more people):
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Address and Effective Dates
Primary Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Contact Preference:
Apartments- Please check all that you are interested in
Cluster Cottages- Please check all that you are interested in
Free-Standing Homes- Please check all that you are interested in
Probable Year of Entry- If you change your mind about your proposed move-in time period or housing choice, please notify the RWC Marketing Office in writing. Preference is given to prospective residents who express a specific year.
Rappahannock Club Signature:
2nd Person Signature:
Todays Date

MonthDayYear
Date
Todays Date

MonthDayYear
Date
Rappahannock Westminster-Canterbury:
Date Received by RWC

MonthDayYear
Date
Priority# (To be assigned by RWC)
All new residents must meet RWC’s health and financial qualifications for residency. We encourage individuals to plan ahead rather than waiting until a significant health need arises. Current residents benefit from the security and peace of mind that comes with guaranteed access to higher levels of care, should they ever need it. Availability for advanced levels of care is reserved for existing residents and may be limited for those applying at the time care is immediately required.

Rappahannock Club Deposit

$1,000.00 Quantity
Item subtotal:

Payment Methods

Credit Card

Google Pay

ACH Bank Transfer

Please be advised that if payment is made by credit card and a refund is subsequently requested, the refunded amount will be $1,000 less any applicable credit card processing fees.
Should be Empty:

Rappahannock Club Registration

*

Payment Methods