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I want to find a Homesharer
I want to find a Homesharer
hsadmin
2021-05-15T07:34:25+00:00
Householder registration form
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Let's start!
Are you the Householder?
(Required)
Tick 'I am a Householder' if you have a spare room and looking for someone to move into that room (a Housesharer). This person will give you up to 10 hours of support a week. Tick 'I am applying on behalf of a Householder', if you are applying on behalf of someone who has a spare room and looking for someone to live there.
I am the Householder
I am applying on behalf of Householder
I confirm that I have permission to complete this application on behalf of the Householder
Yes
No
End of application
We're sorry, but you have stated that you don't have permission from the Householder to complete this application. If you want to talk about an application, please contact us at dominic.ellison@homesharemendip.org.
Applying on behalf of the Householder
Your Name
First
Last
What is your relationship with the householder?
Family member
Friend
Carer
Professional support (social worker etc)
Other
Will you be the primary contact during the application procedure
Yes
No, the householder will be the primary contact
Other
Your Email Address (leave blank if no email address)
Enter Email
Confirm Email
Your Phone
I prefer to be contacted via
Email
Phone
Other
Best time to call you
Mornings
Early afternoon
Late afternoon
Anytime during work hours
Householder Information
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
I prefer to be contacted via
Email
Phone
Other
Best time to call you
Mornings
Early afternoon
Late afternoon
Anytime during work hours
Do you own this property?
Yes
No
How many spare bedrooms do you have?
How many bathrooms do you have?
Is there parking?
On the drive
On street parking with permit
On street parking not requirning a permit
No parking
Other
Do you have any access requirements?
Yes
No
Other
Please give us details of how we can make this service as accessible as possible for you
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 do you feel a potential Homesharer should know about you?
Householder Information
(applying on behalf of a Householder)
Householder Name
First
Last
Householder Address
Street Address
Address Line 2
City
ZIP / Postal Code
Householder Email Address (leave blank if no email address)
Enter Email
Confirm Email
Householder Phone
Householder prefers to be contacted via
Email
Phone
Not at all (contact me instead)
Other
Best time to call Householder
Mornings
Early afternoon
Late afternoon
Anytime during work hours
Does the Householder own this property?
Yes
No
How many spare bedrooms does the property have?
How many bathrooms does the property have?
Is there parking?
On the drive
On street parking with permit
On street parking not requirning a permit
No parking
Other
Does the Householder have any access requirements?
Yes
No
Other
Please give us details of how we can make this service as accessible as possible
If Householder has 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 the Householder's hobbies and interests
What do you feel a potential Homesharer should know about the Householder?
How Homeshare Mendip can help
Would like support with
Cooking
Cleaning
Shopping for food
Gardening
Looking after pets
Basic DIY
Support me with using computers
Basic household chores
Driving me to activities/ church/ clubs/ similar
General companionship
General companionship
Other
If ticked Other, then what would you like a Homesharer to help with that isn't specified above?
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)
Does anyone smoke in the property?
Yes
No
Is there a pet at the property?
No pet
Dog/s
Cat/s
Caged pets (rodents, reptiles etc)
Other
Would it be necessary for a Homesharer to observe any of the following dietary restrictions?
Vegetarian
Vegan
Halal
Kosher
Nut free
Other
Would you be happy for Homesharer to
Tick all that apply
Have a friend visit
Have their partner, who you have met first, visit
Have their partner, who you have met first, occasionally stay the night
Have their child visit
Have their child occasionally stay the night
Why do you feel that Homeshare is right for you/ this property?
Almost done, last bits of details
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
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.
Comments
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