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I want to find a Householder
I want to find a Householder
hsadmin
2021-05-15T07:35:25+00:00
Homesharer registration form
Step
1
of
7
14%
Let's start!
I am applying to be
(Required)
A Homesharer by myself
Part of a couple hoping to homeshare
A parent with child hoping to homeshare
Other
If you have a child, how old are they?
What area do you hope to find a homeshare in?
Frome
Glastonbury
Shepton Mallet
Street
Mells
Other
Your Name
First
Last
What is your pronoun (optional)
People do not always use the pronoun that you may expect based on their name or appearance.
Your age (optional)
Your Address
Street Address
Address Line 2
City
ZIP / Postal Code
Your Email Address (leave blank if no email address)
Enter Email
Confirm Email
Your Phone Number
I prefer to be contacted via
Email
Phone
Other
Best time to call you
Mornings
Early afternoon
Late afternoon
Anytime during work hours
A bit more about you
Do you have a pet?
Yes
No
What pet do you have?
Are you a smoker?
If you are a smoker, you can of course still homeshare.
Yes, I'm a regular smoker
Yes, I smoke very rarely
No
Do you observe any dietary restrictions?
Vegetarian
Vegan
Halal
Kosher
Nut free
None
Other
If there are any specific nuts you are allergic to, please list
Please write what dietary restrictions you observe
Would you be prepared to cook food for somebody who doesn't observe your dietary restrictions?
Yes
No
Not applicable
Other
Do you have a car?
Yes
No
Do you have any access requirements?
Yes
No
Please give us details of how we can make this service as accessible as possible for you
I am
Employed full time
Employed part time
Self employed
Studying
Retired
Currently unemployed
Receiving long term disability related benefits
Other
If you have any health conditions or allergies, please list them below.
Your answers will not prohibit a homeshare arrangement but helps to guide us through the matching process
Tell us about your hobbies and interests
What is the first thing we should tell a householder about you by way of introduction?
What else do you feel a potential Householder should know about you?
How I could support a Householder
I can support with
Cooking
Cleaning
Shopping for food
Gardening
Looking after pets
Basic DIY
Support with using computers
Basic household chores
Driving me to activities/ church/ clubs/ similar
General companionship
Other
If ticked Other, then what other support could you give?
This could be any skills or hobbies you have, which a Householder might like to learn.
Would be happy to share home with
Tick all that apply
A woman
A man
A couple
A parent and child
A parent and children
A smoker
Someone who has a cat
Someone who has a dog
Someone who has a caged pet (for example rodent, reptile)
Would you be happy to share a house with a pet?
No pet
Dog/s
Cat/s
Caged pets (rodents, reptiles etc)
Other
I would expect the Householder to allow me to
Tick all that apply
Have a friend visit
Have my partner, who they have met first, visit
Have my partner, who they have met first, occasionally stay the night
Have my child/ren visit
Have my child/ren occasionally stay the night
Why do you feel that Homeshare is right for you?
Almost done, last bits of details about you
How important is tidyness to you
Not very important
Moderately important
Very important
How important is cleanliness to you
Not very important
Moderately important
Very important
How much conversation do you like to have
Mostly peace and quiet
Love to chat a lot
Sometimes chatty, sometimes not
I would describe myself as
An early bird
A night owl
Kind of in between early bird and night owl
I would expect to normally be home
Every night
Most night
Less than 3 nights a week
Other
I would expect to normally be
Away at weekends
Home most weekends
Other
On weekdays I will usually be
Please tick where you are currently most likely to be. We realise this might change with changes in Covid restrictions.
At home
At work/ study place
Other
Referee 1 (of 2)
Please enter the details of employer or place of study, if you have one. No contact will be made with them without your consent.
Name
Email address
Phone Number
Relationship with you
I have consent from the referee to share these details with you
Yes
No
Referee 2 (of 2)
Please enter details of your second referee. No contact will be made with them without your consent.
Name
Email address
Phone Number
Relationship with you
I have consent from the referee to share these details with you
Yes
No
Your consent
Your consent
(Required)
Your privacy is important to us
Here at Homeshare Mendip we take the privacy of your data seriously. We will only use your personal information for xxx purposes and for communicating with you about your registration.
Only the Executive Director will be able to access your details. More information about how we look after your data can be found in our
privacy policy
. We will never share or sell your data without your prior permission.
I agree to the privacy policy.
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