2023-2024 Night Shelter - Emergency Shelter Application

Page 1

Our shelters operate for around 19 weeks during the Winter months.

· The shelters are in a different venue each day of the week and you will be provided with a map on entry. All venues are local to each other.

· You will be sharing a sleeping are space with up to 34 other guests.

· We provide you with a sleeping bag and mat on your first night for use on the floors of the halls.

· All guests must follow our golden rules to stay in the shelters, failure to do so will result in a loss of place. Golden rules include things like being respectful to others, and no alcohol or drugs in the service. Staff are available at all times.

· You must attend every night (unless previously agreed with a member of staff) or your place will be taken by another guest.

· The service opens at 7:15pm, and you must arrive by 8pm latest unless previously agreed with a manager.

· A hot meal is served at 8pm, and breakfast is provided in the morning. Everyone leaves the venue at 7am for the church to resume its normal activities.

· You will be provided a map showing where the shelter is each night and a welcome pack that includes important information including local day centres where you can receive lunch, showers, and laundry services.

Example of a Night Shelter sleeping space

Data Protection Statement
Glass Door uses the contact information you provide on this form in order to offer you a place in our night shelter. Information will not be kept longer than is necessary and will be stored in accordance with our Data Protection Policy. For more information please see our privacy policy on our website.

Please confirm you have read the above

I have read the above, I understand what the shelters are and agree to follow our Golden rules if given a space in the shelter

Referral type

Page 2

Contact Details

First name of person requiring shelter

Family name of person requiring shelter

Mobile (guest requires a mobile number)

Personal Details

Country of Nationality (England, Scotland and Wales are at the top)

What is your preferred language(s) for both verbal and written communication?

Gender

All guests are placed in-line with their gender identity. People who do not identify as a man or woman will be contacted to understand what spaces they are most comfortable in.

Pronouns

Date of Birth (DD/MM/YYYY) (must be over 17 to register)

Borough: which area are you most recently associated with?

What is your current housing/sleeping situation eg. Rough sleeping, staying with friends/family, squat, short term housing, unsafe accommodation etc?

We offer both mixed-gender or single gender shelters. Sleeping areas are separated in the mixed-gender shelter. Which do you prefer?

We will do our best to try to ensure we offer you your preferred option but please be aware that this may not always be possible.

Do you need help with an immigration matter?

You do not need to answer this question, it does not affect your referral; our services are open to all, irrespective of immigration status. Your answer will help us allocate the appropriate Caseworker to you.  

Do you have a service animal that would need accommodating in the shelter?

The animal has to be recognised as a service animal to be allowed in the shelter

Dietary requirements?

Referrer information (if relevant)

This information will be used to contact you in the event we cannot contact the guest. Please only list your details if you are happy to be contacted for this purpose

Referrer's name

Referrer Organisation

Referrer Telephone number

Referrer's Email (Name@provider.com)

Preference of shelter area

Please let us know which area(s) you would be happy to go to for shelter. Rate the area in order of preference 1 being most wanted and 3 being least wanted. If you are happy to have shelter anywhere, please put 1 for every area. We will try to offer you a space in the area you want most but please remember that due to high demand this is not always possible.

Kensington and Chelsea

Wandsworth

Hammersmith and Fulham

Notes: Please provide any brief information you think may be useful for us to know, such as details of any accessibility requirements that you have. Be aware that information provided will not be used to prioritise your place on the waiting list

Contact Information