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Book a Helping Hand

Fields marked with a * are mandatory. Please take care to fill in all necessary information. Incorrect or missing information will delay your application. If you are unsure please contact us. This form will form your Agreement with Aid to Freedom Ltd.

Your Contact Information
Surname: *
First Name: *
Home Telephone: *
Mobile:
Email: *
Address: *
Postcode: *
 
Applying on behalf of someone else? Click Here. If not please continue.
   
DOB: *
Local GP Name: *
Local GP Address: *
 
Requirements
Helper to assist with:
Clean: Day Trips:
Laundry: Sit and Chat:
Shopping: Other:
   
Hours Required:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Total Hours: This is the calculated total number of hours in a week.
Management Fee: This is the calculated total management fee based on a 4 week (28 days) month.
 
Payment
First fee payment: Credit and Debit Card payment for the first quarter will  be taken over the telephone before the cleaner is introduced.

Second and subsequent payments are made by recurrent automatic card payment or via standing order  *
Monthly payment: Quartely payments are to be made by recurring card transaction automatically or via a standing order. *
 
Comments
Comments:
 
Confirmation and declaration

By submitting this form, I confirm that I have read, understood and agree to the terms and conditions of the agreement and declare the information I have submitted to be correct. I also understand that this online form will be my agreement with Aid to Freedom Ltd and that the agreement will not start untill the introduced cleaner starts cleaning for me.

Aid to Freedom will contact you by phone to confirm the booking and agreement within 48 hours of getting this form. Thank you for Choosing Aid to Freedom
 
I accept the above declaration and terms and conditions.