KindCare Staffing - Live-in Carer Request Form
Client Information
Please leave as must detail as possible. DISCLAIMER: KindCare Staffing acts as an introductory agency only. All carers are self-employed, and clients contract directly with the carer. KindCare does not employ carers, manage care, or accept liability for care delivery. Our role is to introduce you to vetted carers who meet your requirements.:
Name
First Name
Last Name
Relationship to the person needing care? (Self, Parent, Spouse, Relative, other.)
Email
example@example.com
Telephone Number
Address (where the care will take place)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
About the Person Requiring Care
Name
First Name
Last Name
Age
Medical conditions/Needs?
Level of support required? (Tick all that apply)
Personal Care (washing, dressing, toileting)
Medication reminders
Meal Preparation
Housekeeping / light domestic help
Companionship
Mobility Support / Hoist use
Other
Live-In Care Preferences?
Preferred start date?
-
Month
-
Day
Year
Date
Placement length (Short term/Long term/On-going)
Gender preference (If any)
Female
Male
Doesn't Matter
Language or cultural preferences?
Pets in the home?
Any special requirements (dietary, behaviour support, night care etc.)
Household Information
Who else lives in the property?
Type of property?
House
Bugalow
Flat
Other
Spare room available or carer?
Yes
No
There will be once confirmed
Internet/wifi provided?
Yes
No
Will discuss this
Budget & Payment
Expected weekly budget for live-in care?
I understand payment will be made directly to the self employed carer (KindCare acts as an introductory agency only.)
Yes
GPDR & Consent
I consent to KindCare Staffing processing my data for the purpose of introducing a suitable live-in carer.
Yes
I understand that KindCare Staffing acts as an introductory agency only. Carers are self-employed, and the contracts are made directly between myself and the carer.
Yes
I agree and understand there is an introductory fee of £495, which is payable once a live in carer has been confirmed for your household. After this you contract directly with the carer for on-going payments.
Yes
Submit
Should be Empty: