We're ready to help — please submit a Family Profile.

A homecare specialist will contact you within 24 hours. You can also print and submit this form by fax (604.568.6568).


Family Profile

Your name *
Your name
Address *
Address
Location where care will take place
Primary phone *
Primary phone
Secondary phone
Secondary phone
Spouse name
Spouse name
If applicable.
The type of homecare arrangement you are seeking.
Care required
Please check all that apply. Housework can include cleaning, shopping and food preparation, driving, and/or household administration.
Will the caregiver be required to drive as part of homecare duties?
Please indicate the # of days/week when homecare will be required.
Days Off
Please indicate the days (if any) when you will need no homecare.
Would the caregiver be required to accompany your family on vacation?
Please indicate average or typical # of homecare hours required per day.
Please indicate the gross HOURLY wages you are willing to pay a caregiver, not including benefits (approximately 10% of salary for the Employer's portion of Unemployment insurance premiums and Canada Pension Plan premiums).
$
Desired start date *
Desired start date
Please indicate approximate date, +/- 1 week if possible.
Live-in caregivers must be provided their own room.
List names, ages and gender of children in the home.
If any, please indicate.
Smoking allowed in the home? *
If a caregiver will be responsible for children, answer all questions in this section. If not, please go to "Disability Care Requirements".
Infant care duties
Please check all required duties to be performed by caregiver.
Child care duties
Please check all required duties to be performed by caregiver.
Please indicate if one or more of your children require any special care.
Please indicate if your home is expecting a new baby, or if you are planning.
Disability care requirements
Please check all required duties to be provided by the caregiver.
If lifting is required for senior or disabled client, please indicate person's weight.
Household duties
Please indicate any expectations for the caregiver to perform household duties as part of their work. If none, please go to "Your Name"
Meal preparation