Helping support the Elderly
in South Tyneside

Would you like to arrange for someone to be visited by one of your volunteers

If you or someone you know are interested in being visited by one of our volunteers, please complete the form below.
* indicates a required field

Please note; As our resources are limited, it is important that we use them as best we can, offering those that can get out and about, or already have some level of visits to their home, the chance to visit one of our Happy Hubs instead.

If you would like to refer someone to our Happy Hubs, please select the Happy Hubs Tab.


Befriendee Details:

First Name*
Last Name*
Date of Birth*
  dd/mm/yyyy

Gender
Please indicate their ethnic origin

Telephone*
Does the befriendee have an email address?

Location
  We use this to help allocate our volunteers

Address*
 
Town / City*
County*
Post code*

Additional Contact

Name
Telephone
Email
Relationship
Should this be the first point of contact?

Hobbies and Interests:

Please tell us what you can about the potential befriendee, for example, their hobbies and interests.

 
Does the befriendee smoke?
Does the befriendee have any pets?

Befriendee Preferences

In order to help us "match" the befriendee up with a person to visit them we would be grateful if you could answer the following questions:

Do they have a preference whether their visitor is a male or female?
Do they have a preference as to what time they would prefer a visitor to call?

Additional Information

Is the person housebound?
Does the person use a wheelchair?
Is the person able / willing to socialise ?
Does the person have any memory problems?
Does the befriendee already receive visits on a regular basis?
For example by carers, relatives
Are there any known risks associated with this person?

Referring Information

Please indicate who is referring the befriendee to the Happy at Home Project?
Contact Name*
Contact Telephone*
Contact Email

Where did you hear about
the Happy at Home Project?

Please confirm you are happy to receive emails from the Happy at Home Project.

 
Happy at Home

Telephone: 0191 529 2122

Email: info@happyathomesouthtyneside.co.uk

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Hours of Business: 9 - 5 Monday to Friday

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Churches Together In South Tyneside

Representing 70 churches: Anglican, Baptist, Independent, Independent Methodist, Methodist, Roman Catholic, United Reformed

Registered Charity Number: 1153612

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