ILO Host Registration - Lutheran Disability Services

Register to be an ILO Host:

Primary Host Details

Name *

E-mail *

Phone *

Address *

DOB *

Gender

Religious beliefs (optional)

Cultural background (optional)

Do you identify as Aboriginal or Torres Strait Islander? *

What is your current employment status? *

If yes, please detail the folowing:

Employer

Occupation

Employment Status (Full Time/Part Time/Casual)

Length of time in Role

Do you have any experience caring for someone with a disability? If yes, please describe.

Any additional information about yourself including hobbies, skills or interests you would like to share:

Other Household Members

Are there any other tenants in the property where you live? *

If yes,

Please list the Full Name, DOB, and Gender of all members over the age of 18

Are there any minors in the property? *

If yes,

Please list the Full Name, DOB, and Gender of all minors in the property

About your Home:

Can you describe your current accommodation?

How many spare rooms are currently in the property?

How many people currently live in the house?

Do you have any pets?

Is your house equipped with wheelchair accessibility such as ramps? Please describe.

Client Matching Preferences

The following questions will best describe the client you would consider sharing your house with.

Is there a preference of age range? If so, please detail

Is there a preference of gender? If so, please detail

Are you prepared to do any personal care for a client?

Any other comments

All persons residing at the host property aged 18 and over will be required to provide prior to client matching:

NDIS Worker Screening Check
Evidence of Comprehensive Car Insurance
Evidence of Personal Liability Insurance
Evidence of Home and Contents Insurance
Copy of Drivers Licence
Australian Passport/ Birth Certificate/ Australian Passport or VISA proving your right to work in Australia
NDIS Worker Orientation Module
Senior First Aid, CPR and Manual Handling Certificates
Working with Children Check (If required)

If you wish to find out more about being a host or host family, please contact Tenny Der Grigorian on 0401 057 213 0r tdergrigorian@ldssa.org.au for more information.