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