Formulaire d'inscription

Registration Form

Cohabitation request: you are looking for a house/apartment to share.
Date

MonthDayYear
Date
Name

First nameFamily name
Address

Civic number and street

Complément d'adresse

Municipality/villageProvince/Region/State

Postal code/Zip code
Phone
Please enter a valide phone number.Format: (000) 000-0000.
Email
example@example.com
Your age bracket:

Profile of the ideal host
The ideal host:
Personality, lifestyle, etc.
What's really important concerning the host (sleep schedule, noise, activities, use of shared spaces, visitors, music, etc.).
Criminal record check
Do you authorize Avignon Home Sharing (Groupe ressource en logements collectifs GÎM) to have a specialized company conduct a criminal background check on you for the purpose of cohabitation?
*Answering 'No' may reduce your chances of finding someone to live with.

References

People who know you well and, ideally, have already lived with you.
Name

First nameFamily name
Phone number
Please type a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Relationship with you:
Parent, friend, colleague, former or current roommate, etc.
Name

First nameFamily name
Phone number
Please type a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Relationship with you:
Parent, friend, colleague, former or current roommate, etc.

Registration Form