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

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
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
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.  *
* indicates that you must supply an answer