Grandview, TX · Johnson County
Caring-Heart Membership Application
This application lets City of Grandview Water customers request CareFlite Caring-Heart membership for themselves and eligible household family members.
What this form is
The application is for City of Grandview Water customers who want to enroll in CareFlite’s Caring-Heart Membership Program. It requests contact and household information, dates of birth, health insurance details, and a signature agreeing to the program terms. The form states the membership fee is $1 per month and that membership takes effect when utility service starts and the fee is paid.
Who needs it
A City of Grandview Water customer who wants to enroll themselves and eligible household family members in CareFlite’s Caring-Heart Membership Program should complete this application.
How to submit it
Return the completed application to the City of Grandview Water for processing.
About notarization
This document is signed without a notary; the signer just signs and dates the application.
How to submit this form
- 1
Download The Application
Download the Caring-Heart Membership Application PDF.
- 2
Complete The Application
Enter the requested personal, contact, insurance, and household family member information.
- 3
Review And Sign
Review the program terms, then sign and date the application.
- 4
Return The Application
Return the completed application to the City of Grandview Water for processing.
Frequently asked questions
- Do I need a notary for the Caring-Heart Membership Application?
- No. The application has a signature and date line but no notary block; the signer just signs and dates it.
- How do I submit the Caring-Heart Membership Application?
- Return the completed application to the City of Grandview Water for processing.
- What information does the application ask for?
- It asks for the applicant’s contact details, date of birth, health insurance information, and information about household family members to be covered.
- What is the Caring-Heart membership fee?
- The application says CareFlite membership is $1 per month and becomes effective when the customer starts City of Grandview Water service and pays the membership fee.