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WEBSITE CURRENTLY IN DEVELOPMENT... PLEASE BARE WITH US

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community SUPPORT

community donations

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Community Home Care
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PUBLIC SUGGESTION FORM

Suggest someone or apply for support from Renovate Community Repair

PUBLIC SUGGESTION FORM

COMMUNITY SUPPORT

ORGANISATION REFERRAL FORM

a NOMINATION OR SELF – REFERRAL FOR SUPPORT

Please complete the form below

Nominate someone or request support

Your Name: *person making support request

Your Best Contact Number: *

Your Email Address: *

Confirm Email Address *

Address *

Town/ City *

County *

Post Code *

I CONFIRM MY INFORMATION IS CORRECT, I ALSO CONFIRM... *
I have read and agree to the privacy & cookies policy and Renovate Community Repair's terms and conditions documentation (published at the bottom of RCR'S website)

Applicants Full Name: *

Applicant Phone No: *

Applicant Email Address: *

Confirm Email Address *

Applicant Date of Birth *

Applicant Preferred Contact Method

Applicant Address *

Town/ City

County

Post Code

Does the applicant have vulnerabilities?Helps with prioritisationAt Risk GroupDisabilityElderly PersonHealth ConditionLow IncomeSingle ParentOther

I CONFIRM I AM APPLYING WITH PERMISSION & ON BEHALF OF THE APPLICANT AND THEIR DETAILS ARE CORRECT, I ALSO CONFIRM... *
I have read and agree to the privacy & cookies policy and Renovate Community Repair's terms and conditions documentation (published at the bottom of RCR'S website)

Repairs/ Maintenance Support RequestedDescribe the issues

How long has the problem persisted

Date of RequestDate of support request

Urgency(to help with prioritisation)

Risks to Applicant(if the problems are not addressed)

Barriers/ ConstraintsE.g. landlord permission, financial cost, access, physical barriers

Household Composition & Notes for consideration during application:So we may understand the scale of need & prioritise

I CONFIRM THE APPLICANT HAS CONSENTED TO BE CONTACTED BY RCR IN RELATION TO THE INFORMATION IN THIS FORM, I ALSO CONFIRM *
I have read and agree to the privacy & cookies policy and Renovate Community Repair's terms and conditions documentation (published at the bottom of RCR'S website)

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CONTACT

FAQ'S

07707812997 OR 07707812999

LIVERPOOL CITY REGION

Normal Hours 9am to 5pm

admin@renovatecommunityrepair

A Community Interest Company, Company no: 15729236, 101 North Mersey Business Park, Merseyside, L33 7UY

Terms & POLICIES

WEBSITE TERMS

PRIVACY & COOKIES

GENERAL TERMS

WORKING TERMS

PAYMENT TERMS

HEALTH & SAFETY

COMMUNITY HOME CARE TERMS

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