Vineyard Village at Home Membership Agreement Today
Online Application

Terms: Vineyard Village at Home ("VVAH") is a non-profit corporation, founded by Martha's Vineyard residents, dedicated to providing support to Martha's Vineyard residents who wish to remain in their own home as they age. To fulfill this mission, VVAH has identified third-party providers who will carry out the bulk of the services and activities requested by VVAH members.

A VVAH annual membership costs $475 for individuals and $600 for households. Membership fees are paid annually. Membership will commence on the first day of the month that you pay your fee and will continue for the next twelve consecutive months. As a VVAH member, you are entitled to all of the attributes and benefits that membership offers.

VVAH works with its members to determine needed and requested services and activities. VVAH has identified providers to carry out such services and activities. VVAH will maintain quality control and attempt to establish discounts on services for its members.

VVAH will make every attempt to coordinate services and work with existing Island agencies.

Most services will be offered on a fee-for-service basis. VVAH members will contract directly with these providers, will receive preferred treatment, and in many cases, discounts from these providers.

VVAH is committed to ensuring that its members receive the highest caliber of service and satisfaction with the program; however, VVAH does not assume any direct or indirect responsibility or liability in connection with services contracted by members with third party providers recommended by VVAH.

Agreement: To enable VVAH to maintain a high level of membership satisfaction, in a situation where concerns regarding a member's safety or health arise, VVAH reserves the right to contact the individual(s) listed on the member's contact sheet. Third-party providers may share with VVAH non-medical data pertaining to the services used by VVAH members.

AS A VINEYARD VILLAGE AT HOME MEMBER, I HEREBY RELEASE AND DISCHARGE VINEYARD VILLAGE, INC. FROM ALL RESPONSIBILITY OR LIABILITY FOR SERVICES RENDERED BY ANY THIRD-PARTY PROVIDERS, AND I AGREE TO HOLD VINEYARD VILLAGE, INC. AND ITS EMPLOYEES, OFFICERS AND DIRECTORS HARMLESS FROM AND AGAINST ANY COST, EXPENSES OR DAMAGES (INCLUDING WITHOUT LIMITATION, REASONABLE ATTORNEY'S FEES) ARISING IN CONNECTION WITH ANY AND ALL CLAIMS BROUGHT BY OR THROUGH ME, INCLUDING BUT NOT LIMITED TO CLAIMS BROUGHT BY MY INSURANCE CARRIER.

I have read the above carefully and agree to the terms and conditions of Vineyard Village at Home membership as described. Member 1 — First Name:  Last Name:  Member 2 — First Name:  Last Name:  Street Address:  City:  State:  Zip:  Phone #:  Email Address:

 
vineyardvillage.org • Vineyard Village at Home, PO Box 1356, Vineyard Haven, MA 02568 • 508.693.3038