How to Apply

To apply for the services provided by Seniors Life Enhancement Centres please fill out the referral form linked below. The form can be submitted online, faxed or mailed to the Centres. We also accept referrals by telephone.

Adult Day Program Referral Form

The programs offered by Seniors Life Enhancement Centres are designed for Mississauga residents over the age of 60 who have physical impairments that interfere with their capacity to function independently or who have memory impairments. The program offers social and recreational activities that enhance the quality of life of our clients, while providing respite for caregivers.

All potential clients will be assessed by staff of the Centres

This referral is for Circle of Friends (for seniors with memory impairment or frailty).

This referral is for Gathering Place (for seniors with physical disabilities).

Referral Source Name:

Referral Source Organization:

Referral Source phone number:

Referral Source email address:

Client’s name:

Caregiver’s name:

Contact Name:

Contact Number:

Relationship to client:

Please indicate the diagnosis of the client and/or current functioning level (for example: memory loss, uses a wheelchair, has had a stroke…)