Provider Interest Form

If you are interested in offering respite or companionship support in your local area, please complete the form below.

This helps us understand you experience, availability and travel preferences. If there are potential matches with families seeking support, we will contact you to discuss next steps, including safeguarding requirements such as PVG and Insurance.

Full Name

First

Last

Email Address

Location (Postcode)

Availability

Which of these best describes you?

Which of the following would you feel comfortable supporting?

Accompanying walks or outings
Driving a client to activities
Supporting someone using a wheelchair
Supporting someone with dementia
Quiet companionship at home

Do you currently have a Protection of Vulnerable Groups certificate with an existing employer or organisation?

I confirm I have PVG
I’m not sure and would like guidance

What is your current insurance status?

I already have appropriate insurance for this type of work
I have insurance but would need to check whether it covers this work
I do not currently have insurance but would be willing to arrange it if I begin supporting a family
I’m not sure and would like guidance

How far are you generally willing to travel for support work?

Up to 5 miles
Up to 10 miles
Up to 20 miles
Happy to travel further by agreement

Would you accept shorter visits if travel is required?

Yes
Prefer visits of at least 2 hours if travel is involved
Prefer longer visits if travel is involved

How do you typically approach 'travel to client' costs

10 miles (both ways) included in hourly rate
15 miles (both ways) included in hourly rate
20 miles (both ways) included in hourly rate
25 miles (both ways) included in hourly rate

What is your 'during shift' mileage rate?

HMRC mileage rate (currently 45p per mile)
My own agreed mileage rate
Happy to discuss with the family

RespiteConnect providers operate independently and set their own rates. For reference, many respite and companionship providers in our area charge around £15–£25 per hour, depending on experience and responsibilities. What hourly rate would you typically expect for this kind of support?

Additional Notes

Please confirm the following

I have read and agree to follow the RespiteConnect Code of Conduct

RespiteConnect exists to create safe, respectful, and professional connections between families, carers, and independent respite providers. All users of the platform are expected to adhere to this Code of Conduct.

For Providers
All providers listed on RespiteConnect agree to:

Safeguarding & Legal Requirements

Hold a current PVG membership through
Disclosure Scotland

Maintain appropriate insurance policies at all times

Notify RespiteConnect immediately if safeguarding status changes

Professional Conduct

Treat all clients with dignity, respect, and compassion

Maintain clear professional boundaries

Be punctual, reliable, and communicative

Only provide services they are competent and insured to deliver

Scope of Support

Provide community-based respite and companionship only

Do not offer medical or regulated care unless appropriately qualified and insured

Confidentiality

Respect client privacy

Do not share personal information without consent

Keep any records secure and confidential

Payments & Agreements

Set your own rates

Provide clear, regular invoices to clients

Be paid directly by clients

Manage your own tax and legal obligations

Understand that RespiteConnect is not your employer

Reputation & Community Standards

Act honestly and ethically

Avoid discrimination or exploitation

Follow RespiteConnect’s guidelines and policies

Breaches may result in removal from the platform

for many current

Please confirm the following

I understand that providers operate independently and are not employees of RespiteConnect.

Please confirm the following

I understand that appropriate safeguarding checks (such as PVG membership where required) and suitable insurance must be in place before providing support.

Please confirm the following

I consent to RespiteConnect storing and processing the information provided in this form for the purpose of connecting families and providers.

Privacy Policy
Introduction

RespiteConnect is committed to protecting your privacy and handling personal information responsibly.

This Privacy Policy explains how we collect, use and store personal information when you use the RespiteConnect website or submit information through our forms.

RespiteConnect operates as a Community Interest Company focused on connecting families with independent respite providers.

What Information We Collect –

We may collect the following information when you submit a form or contact us:

Contact information

Name

Email address

Phone number

Location (town or postcode area)

Support or provider information

For families:

General information about the type of support requested

For providers:

Information about availability, experience, travel preferences and general suitability.

We aim to collect only the information necessary to help facilitate suitable introductions.

We do not request detailed medical information through initial forms.

How We Use Your Information –

We use your information to:

Respond to enquiries

Facilitate introductions between families and respite providers,

Understand demand and availability within the local community,

Improve the development of RespiteConnect services,

We do not sell or share personal data for marketing purposes.

How Information May Be Shared –

Information may be shared in a limited way where necessary to facilitate an introduction.

For example:

A family’s contact details may be shared with a suitable provider,

A provider’s contact details may be shared with a family seeking support,

Information will only be shared for the purpose of arranging potential support connections.

Data Storage –

Information submitted through the website is stored securely using website hosting and form systems.

We take reasonable steps to protect personal information and prevent unauthorised access.

We retain information only for as long as necessary to manage enquiries and potential connections.

You may request deletion of your information at any time.

Your Data Rights –

Under UK data protection law you have the right to:

Request access to the information we hold about you,

Request corrections to inaccurate information,

Request deletion of your data,

Withdraw consent for us to hold your information,

To exercise these rights, please contact us using the details below.

Cookies –

The website may use basic cookies to support website functionality and analytics.

Cookies do not typically identify individuals but help us understand how visitors use the site.

You can control cookie settings through your browser.

Contact –

If you have questions about this Privacy Policy or how your data is handled, you can contact:

RespiteConnect
Email: info@respiteconnect.org

Changes to This Policy –

This policy may be updated as RespiteConnect develops. Any updates will be published on this page.

Governing Law –

This policy is governed by UK data protection legislation including the UK GDPR and the Data Protection Act 2018.

Please confirm the following

I understand that RespiteConnect facilitates introductions only and does not supervise or manage support arrangements