Wisconsin Adult Day Services Association

Editing Center

DO NOT ENTER DATA IN THIS FIELD

Register your Center

Welcome to WADSA! Registering your Adult Services Center with WADSA is the first step in joining an association that can help you take your organization to the next level. You are not obligated to join WADSA to have your Center listed here.

Please fill out this form as completely as possible. Also please note your login credentials (your Login e-mail and Login password) – you can come back at any time to update or complete any missing or incorrect information by logging into the site. Check your e-mail for a confirmation link to confirm this application.

We will review your information and contact you shortly with more information about the benefits of WADSA membership.

Contacts —	Name:	Title:
Center name:
Certified:
Login e-mail:		IMPORTANT: Please remember these for future access to this account.
Login password:
Address:		NOTE: Region, city, state, and county data is determined from zip code
ZIP Code:
Email:
Website:
Phone:
Fax:
First:
Second:
Third:
Established:
Affiliation:
Hours:
Capacity:
Avg. Attendance:
Staff part. ratio:
Profit status:
Full Day Rate:
Half Day Rate:
Bath Rate:
Other Rates:
Funding sources:
More details:
Services:	Bathing Beautician/Barber Intergenerational Visits Meals Music Therapy Nursing Overnight Respite Personal Care Pet Therapy Physician Podiatry Recreational Therapy Rehabilitation (Occupational, Physical and Speech Therapy) Social Worker/Social Services Support Group Transportation
Focus:	Medical Rehab Dementia Health Maintenance Social