Shared Lives Carer Enquiry Form

If you are interested in becoming a Shared Lives carer please complete the enquiry form below. This be followed up with a telephone call from one of our Business Support Officers.

If you want to know more about the service we provide to people please give us a call on 01772 531326 or email sharedlives@lancashire.gov.uk

First name *

Surname *

Postcode *

Address *

Email address *

Telephone *

What type of Shared Lives carer do you want to be
(Choose all that apply) *

Long term/permanent placements - A person will come to live in your home on a long-term basis

Short term breaks - From one night to a few weeks. It may be 'one-off' or on a regular basis

Which group of people do you want to support
(Choose all that apply) *

People with a learning disability

Older adults

People with physical disabilities

People with mental health issues

Other:

Any other details you would like to tell us *

Where did you hear about Shared Lives
(Choose one) *

Recommended by a shared lives carer

LCC job vacancies

LCC Facebook or Twitter

LCC website

Word of mouth

Other:

The information you have provided above will be held on our database and will be used to assess your suitability as a carer, it will also be used for statistical purposes. Please tick here if you provide consent for this information to be held and used as stated. *

Confirm

* indicates that you must supply an answer