Sign Up – Thriving Silver Minds

Your InfoAbout YouDisclosuresAgreement

Who Are We Welcoming?

Tell us about the person joining.

I am signing up

For MyselfI am the senior joining

For a Loved OneI'm signing them up

Member's Information

First Name*

Last Name*

Date of Birth*

Phone*

Email*

City & State*

Your Information

Your First Name*

Your Last Name*

Relationship*

Your Phone*

Your Email*

Tell Us About You!

The more we know, the better your Care Specialist can match you.

Interests & Hobbies

Which Circle Sounds Most Interesting?

Technology Comfort*

Preferred Schedule

Anything Else?

Important Information

Please read carefully. Written in plain language.

⚕️ We Are Social Wellness — Not Medical Care

Thriving Silver Minds LLC is not a licensed medical provider, therapist, or clinical healthcare provider. Our services are social and recreational only. This does not create a patient-provider relationship.

💬 What Our Services Are

Virtual social wellness programming: guided group sessions, recreational activities, and community connection led by trained facilitators — not clinical professionals.

🔒 Privacy

All personal information is kept strictly confidential. We never sell or share your information. Sessions are not recorded without explicit consent.

💳 Billing & Cancellation

$79/month. Payment taken by phone by your Care Specialist — nothing charged without your verbal authorization. Cancel anytime, no penalty. Pro-rated refunds within 5–7 business days.

⚠️ Limitation of Liability

TO THE FULLEST EXTENT PERMITTED BY LAW, THRIVING SILVER MINDS LLC AND ITS TEAM SHALL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL, OR CONSEQUENTIAL DAMAGES. Total liability shall not exceed amounts paid in the 30 days preceding any claim.

🤝 Code of Conduct

All participants must treat fellow members and hosts with respect and kindness. Harassment or disruptive behavior may result in removal without refund.

Your Agreement

Please check each item. Items marked * are required.

* I have read and agree to the Terms of Service and Privacy Policy of Thriving Silver Minds LLC.

* I understand Thriving Silver Minds is not a medical provider, therapist, or clinical service. I am enrolling in a social and recreational wellness program only.

* I acknowledge the Limitation of Liability and agree that Thriving Silver Minds LLC shall not be liable for indirect, incidental, or consequential damages.

* I understand membership is $79/month, taken by phone. No charge without my verbal authorization. I understand the cancellation and refund policy.

* I agree to the Code of Conduct. Disrespectful behavior may result in removal.

* I confirm the person being enrolled is 55 years of age or older.

* For Family/Caregiver — I confirm I am legally authorized to enroll the above-named member and accept personal responsibility for payment and compliance.

Electronic Signature

By typing your name and today’s date, you sign electronically and confirm all information is accurate.

Full Name*

Today’s Date*

I am signing as*

What happens next: Your Care Specialist calls within 24 business hours. No payment is collected through this form. Everything handled warmly by phone.

🔒 Your information is private. See our Privacy Policy.

🎉

You’re Registered!

Welcome! Your Care Specialist will call within 24 business hours. We’re so glad you’re here! ♥

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Questions? Contact us — we respond within 24 hours.

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Who Are We Welcoming?

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Important Information

Your Agreement