Application for Elderly Day Care Service Apply online for quicker, convenient service. Transportation Available. Long-Term Care Insurance and Veteran Benefits Accepted. Date Caregiver's Name (required) Senior's Name (required) Address, City, State, Zip (required) Email (required) Phone (required) Subject Message Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)