Barrie HomeShare Home Provider Matching Form

Barrie HomeShare Home Provider Matching Form

Personal Information
Full Name *

First Name Last Name
Gender *

Female Male Non-Binary
Vulnerable Sector Screening (VSS)

All participants with the Barrie HomeShare Pilot Project will need to undergo a Vulnerable Sector Screening (VSS) police check. Our staff will assist you in completing this form and Barrie HomeShare will pay the costs. The completed VSS will be mailed to your mailing address directly from Barrie Police Services. Participants must provide a copy of a "Clear" VSS to our staff before they can be matched. This is an important, mandatory step in the process to ensure the safety of all involved.
Have you been convicted of a criminal offence for which a pardon has not been granted under the Criminal Code of Canada? *

Yes No
Do you have unresolved charged under the Criminal Code of Canada? *

Yes No
How would you like us to contact you? Please enter all that apply
Email
example@example.com
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City Province

Postal Code
Neighbourhood
Do you live near transit routes? *

Yes No
If yes, please specify:
ie: walking distance to Barrie Transit Bus stops, etc.
Do you live alone? *

Yes No

If no, please list others who live with you:

Name

Relationship

Please provide at least one emergency contact:

Full Name

Relationship

Phone Number

Please provide three references (family members, friends or personal contacts are okay; email is preferred OR phone number is sufficient):

Full Name

Relationship

Email Address

Phone Number

In order to assist with the matching process, please describe interests, activities or hobbies that you enjoy: *
What languages do you speak?

English Italian Chinese French German Portuguese Polish Dutch Hindi Urdu Spanish Ukranian Russian
References

Please note that we will need to receive replies from at least two references before a participant can be matched.

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