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Guest Registration
I have read the guidance and understand my role as referrer
Referrer Information
Who is making this referral?
Please Select...
I'm referring myself
Charity
Solicitor
Statutory service
Case Worker
Referrer's Name & Organisation
Street Address
Town/City
County/Region
Postcode
Referrer's Email
Referrer's Telephone
I consent to the use of my personal data in accordance with Refugees at Home data policy
Where did you here about us?
Please Select...
FaceBook
Twitter
Website
Word of Mouth
Host Coordinator
Other
Please state what responsibility you will continue to take on behalf of your client to sort out any outstanding issues, such as NASS accommodation, employment, status etc and agree that you will continue to be available as a point of contact should any problems arise.
The following questions refer to the Guest
Guest Contact Details
First Name
Last Name
Email Address
Telephone Number
Date of Birth
Country of Origin
COVID Vaccinated?
Please Select...
No
1st Dose
2nd Dose
2nd Dose + Booster
Guest current situation
Current Living Situation
Please Select...
Hotel
Street Homeless
Staying with Friends/Family
Immigration Removal Centre
Home Office Asylum Support
Street Address
Town/City
County/Region
Postcode
Solicitor name and practice
Date arrived in UK
Guest Immigration Status
Please Select...
Refugee
Asylum Seeker
Refused
Renewed Claim
Other
Student Visa
Stateless
Spousal Visa
Overstayer
Human Rights Application
Survivor of Trafficking
Voluntary Return
Unclear
Humanitarian Protection
LTR - Residency Rule
Family Reunification
Visitor Visa
Ukrainian Sponsorship scheme
Ukrainian Family Visa
Other organisations providing support
What financial support does guest currently receive?
Guest's Personal Details
Who is this application for?
Please Select...
Just the named guest
The guest and their partner
The guest and their family
Other
If other, please clarify who this application is for?
Number of Male Adults (> 18 yr)
Please Select...
0
1
2
3
4
5
6
7
8
Number of Female Adults (> 18 yr)
Please Select...
0
1
2
3
4
5
6
7
8
Number of Children (< 18)
Please Select...
0
1
2
3
4
5
6
7
8
How does the main guest identify their gender?
Please Select...
Male
Female
Transgender male
Transgender female
Non-binary
Other
Prefer not to say
Unknown
Transgender
If other, please indicate the main guest gender
Guest languages (at conversational level or more)
English
Russian
Ukrainian
French
German
Spanish
Polish
Arabic
Farsi
Tigringya
Other
If other, please indicate the guest languages
What is your highest level of education?
Please Select...
No Schooling Completed
Finished Primary
Finished Secondary
University/college degree
Post-graduate degree
Does guest have a criminal conviction?
Please Select...
Yes
No
Does the guest have any mobility condition we need to be aware of?
Please Select...
Yes, severe limitations
Yes, Moderate limitations
No limitations
Please explain mobility condition
Guest's accomodation needs
Date placement needs to start
How long is the hosting needed for?
Please Select...
Emergency hosting (<1 month)
1 full month
1 - 3 Months
3 - 6 Months
>6 Months
Does the guest have a preferred location?
Please Select...
Yes
No
Please indicate location preference
London - Any
London - North
London - North East
London - North West
London - East
London - South East
London - South
London - South West
London - West
Birmingham
Manchester
Leeds
Liverpool
Tyne and Wear
Sheffield
Portsmouth-Southampton
Nottingham-Derby
Glasgow
Cardiff
Bristol
Belfast
Edinburgh
Brighton
Other
If other, please indicate location preference
Why does the guest prefer that location?
Any additional details on sleeping arrangements?
Guest's preferences
Does the guest have a problem with any pets?
Please Select...
Yes
No
What type of pets would be a problem?
Please Select...
Cat
Dog
Rodent
Reptile
Bird
Other
If other, please indicate what type of pets would be a problem?
Does guest smoke?
Please Select...
Yes
No
Is the guest vegetarian?
Please Select...
Yes
No
Does anyone in guest's group have any mental health condition?
Please Select...
No
Yes, mild issues
Yes, moderate issues
Yes, severe issues
Please provide details (symptoms, triggers, etc)
Indicate guest's group COVID vaccination status
Please Select...
Not vaccinated
Partially vaccinated
Fully vaccinated
Are there other things that we should be aware of?
Please tell us more about interests and hobbies
Please tell us a little more about the guest i.e what they do in their spare time, personality, how they interact with others and their move-on plan. This information helps us make the best matches when it comes to placements
Note: Refugees At Home will only share this information with those who need it to make and support a placement (our team, potential hosts, home visitors) and as required by law.
I confirm that I have explained the Refugees at Home data policy to the person I am referring and that they give consent for their personal data to be stored and used by Refugees at Home for the purposed of hosting
I agree that all the information provided is true and accurate
I confirm that I understand the scope of services being provided by Refugees at Home