Application Form

By completing this form, if your application is accepted you agree to abide by the Association’s Conditions of Membership.

Care Home Name/Name of Care Provider*

Care Home Address or Place of Business

Telephone Number

Your Email Address*

Care Home or Dom Care Provider Email Address (if different)

Website Address

Category of Registration

Registration Number

Number of Registered Beds (Care home only)

Name of Proprietor(s)*

Address of Each Proprietor

Name of Registered Manager*

Contact Details of Registered Manager

Number of Homes Owned and / or Other Care Provision Businesses

Names and Addresses of Homes / Businesses

As part of the application form please also complete and return to us the General Data Protection form below. If you do not complete this form we will not be able to communicate with you.

DATA PROTECTION

By signing this form you are confirming that you are consenting to SECHA holding and processing your personal data for the following purposes (please tick all the boxes where you grant consent);

I consent to SECHA contacting me by
PostPhoneEmail

YES to share my contact details with SECHA Members so they can keep me informed about news and events organised by SECHAYES To include my contact details in the SECHA DirectoryYES To share my contact details with other organisations only for the purposes of circulating information on behalf of SECHA

You can withdraw or change your consent at any time by contacting SECHA by telephone on 01268 784501 or by e-mail to; philroseman@secha.org.uk

Please note that all processing of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect personal data that has already been processed prior to this point.

Signed

Date

Please tick the box below to confirm you are human*

 

Conditions of Membership

  1. Prior to acceptance all applicants will be visited by representatives of the Association to affirm acceptability.
  2. Staff should be well managed and receive all necessary training.
  3. Staffing levels must be adequately maintained for the type of care provided.
  4. All necessary records should be maintained in accordance with the laid down requirements.
  5. No reimbursement or refunding of fees can be given.
  6. Any organisation applying for membership is required to nominate one individual to be the representative of that member
  7. No care provider who is part of a group or a branch of an organisation may individually be members and all homes or branches of that organisation that is within Essex must become members.
  8. No more than one qualifying person from each care provider who is a member may sit as a Director of the Association. A group or several branches of the same organisation who are members will be treated as a single care provider for this purpose and only one nominee for Directorship will be accepted from the group or branches of the same organisation.
  9. Members shall provide the highest standard of care and understanding for the needs of service users.
  10. The Association reserves the right to refuse or cancel membership.
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