Shared Lives Carer Enquiry Form

If you are interested in becoming a Shared Lives carer please complete the enquiry form below.

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
Preferred method of contact
(Choose one)
Email
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
Daytime support - Support for a few hours a day
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: