{"id":222054,"date":"2025-02-20T10:19:24","date_gmt":"2025-02-20T10:19:24","guid":{"rendered":"https:\/\/thecatholicworkerfarm.org\/web\/?page_id=222054"},"modified":"2025-02-24T16:44:34","modified_gmt":"2025-02-24T16:44:34","slug":"referrals","status":"publish","type":"page","link":"https:\/\/thecatholicworkerfarm.org\/web\/?page_id=222054","title":{"rendered":"Making a Referral"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"222054\" class=\"elementor elementor-222054\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-545a713e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"545a713e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-429e55a4\" data-id=\"429e55a4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-38d8884c elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"38d8884c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><!--nextpage--><\/p>\n<p><!-- \/wp:nextpage --><!-- wp:spacer {\"height\":\"23px\",\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<div style=\"height: 23px;\" aria-hidden=\"true\">\u00a0<\/div>\n<p><!-- \/wp:spacer --><!-- wp:group {\"layout\":{\"type\":\"grid\"}} --><\/p>\n<div>\n<p><!-- wp:heading {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<h2>About the referral process<\/h2>\n<p><!-- \/wp:heading --><!-- wp:paragraph {\"style\":{\"layout\":{\"rowSpan\":1,\"columnSpan\":4}}} --><\/p>\n<p>We accept referrals from all agencies and organisations. To refer someone to The Catholic Worker Farm, please follow these steps, in order:<\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p><strong>1. Call to discuss<\/strong><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p>Call us on Scott\u2019s mobile <strong>07983 477819<\/strong> to discuss the potential referral. We will then confirm if we are able to accommodate your client. Requests are processed on a first-come, first-served basis, though priority may be given to forced migrants and those in particularly difficult situations.<\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p><strong>2. Go through house rules with your client<\/strong><\/p>\n<p><span style=\"color: var( --e-global-color-text ); font-family: var( --e-global-typography-text-font-family ), Sans-serif; font-weight: var( --e-global-typography-text-font-weight );\">The client must read and understand our House Rules, and sign a printed copy (click to download\u00a0<\/span><a style=\"font-family: var( --e-global-typography-text-font-family ), Sans-serif;\" href=\"https:\/\/thecatholicworkerfarm.org\/web\/wp-content\/uploads\/2021\/11\/House-Rules-Form-template.pdf\">here<\/a><span style=\"color: var( --e-global-color-text ); font-family: var( --e-global-typography-text-font-family ), Sans-serif; font-weight: var( --e-global-typography-text-font-weight );\">). Please make sure that you have explained the rules to your client; use language translation tools where necessary.<\/span><\/p>\n<p><strong>3. Complete Referral form<\/strong><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p>The referring organisation must complete our Referral Form (click to scroll down and start <a href=\"#ref-form\">here<\/a>). We require detailed information regarding the client&#8217;s mental health, as we do not have the facilities to safely care for people with severe mental health conditions or symptoms such as psychosis, paranoia, or suicidal ideation.<\/p>\n<p><span style=\"color: var( --e-global-color-text ); font-family: var( --e-global-typography-text-font-family ), Sans-serif; font-weight: var( --e-global-typography-text-font-weight );\"><strong>NB:<\/strong> If unable to fill in the webform, please download the form <a href=\"https:\/\/thecatholicworkerfarm.org\/web\/wp-content\/uploads\/2025\/02\/2025_CWF-referral-form.pdf\">here<\/a> instead and email it to <a href=\"mailto:thecatholicworkerfarm@yahoo.co.uk\">thecatholicworkerfarm@yahoo.co.uk<\/a>.<\/span><\/p>\n<\/div>\n<p><!-- \/wp:spacer --><!-- wp:heading {\"style\":{\"layout\":{\"columnSpan\":2,\"rowSpan\":1}}} --><\/p>\n<h2>Advice for people in need of shelter<\/h2>\n<p><!-- \/wp:heading --><!-- wp:paragraph {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<p>If you are homeless and seeking accommodation, please make yourself known to your local immigration advice service. <strong>If you have a key worker helping you, you can also ask them to refer you to us.<\/strong><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph --><\/p>\n<p><!-- \/wp:paragraph --><!-- wp:paragraph --><\/p>\n<p>We have also compiled a list of other <strong>organisations that may provide accommodation for people without recourse to public funds<\/strong>. Please let us know of any other providers you are aware of so we can expand this list.<\/p>\n<p><!-- \/wp:paragraph --><!-- wp:details --><\/p>\n<details>\n<summary><strong>Click to expand list of alternative accommodation providers:<\/strong><\/summary>\n<p><!-- wp:table --><\/p>\n<figure>\n<table>\n<tbody>\n<tr>\n<td><b>Nationwide<\/b><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/www.justhomes.org.uk\/\">Just Homes<\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/www.spareroom.co.uk\">SpareRoom<\/a><\/td>\n<\/tr>\n<tr>\n<td>\u00a0<\/td>\n<\/tr>\n<tr>\n<td><b>London<\/b><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/www.ashiana.org.uk\/\">ashiana<\/a>: 020 85390427<br \/><em>Focusses on victims of domestic violence<\/em><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/www.sfts.org.uk\/\">Shelter from the Storm<\/a>: 020 7697 9569<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/missionariesofcharity.org\">Missionaries of Charity<\/a>: 020 8969 2631, 020 8960 2644<\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/www.franciscans.org.uk\/hospitality\/\">House of Divine Compassion<\/a>: 020 7474 5836<\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/londoncatholicworker.org\/\">London Catholic Worker<\/a><br \/><em>Men&#8217;s accommodation<\/em><\/td>\n<\/tr>\n<tr>\n<td>\u00a0<\/td>\n<\/tr>\n<tr>\n<td><b>Bristol<\/b><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/bristolhospitalitynetwork.wordpress.com\/\" target=\"_blank\" rel=\"noopener\">Bristol Hospitality Network<\/a><\/td>\n<\/tr>\n<tr>\n<td>\u00a0<\/td>\n<\/tr>\n<tr>\n<td><b>Manchester<\/b><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/boaztrust.org.uk\/\" target=\"_blank\" rel=\"noopener\">The Boaz Trust<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n<p><!-- \/wp:table --><\/p>\n<\/details>\n<p><!-- \/wp:details --><!-- wp:spacer {\"height\":\"40px\",\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<div style=\"height: 40px;\" aria-hidden=\"true\">\u00a0<\/div>\n<p><!-- \/wp:spacer --><!-- wp:separator --><\/p>\n<hr \/>\n<p><!-- \/wp:separator --><!-- wp:heading {\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<h2>Referral Form<\/h2>\n<p><!-- \/wp:heading --><!-- wp:heading {\"level\":5,\"style\":{\"layout\":{\"columnSpan\":4,\"rowSpan\":1}}} --><\/p>\n<h5>To be filled in by the referring agency<\/h5>\n<p><!-- \/wp:heading --><!-- wp:shortcode --><\/p>\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-222071 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-222071\" data-uid=\"69f67d7698132\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-222071\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-222071 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"222071\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f67d7698132\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Referral Requirements<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-1-69f67d7698132-label\" class=\"forminator-label\">I am a keyworker completing this form on behalf of my client. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-1\" value=\"keyworker-yes\" id=\"forminator-field-radio-1-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-1\" value=\"keyworker-no\" id=\"forminator-field-radio-1-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-2-69f67d7698132-label\" class=\"forminator-label\">As a representative for the agency referring this client, I understand that my referral will be automatically rejected if I have not called to discuss it with the Catholic Worker Farm prior to submitting this form. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"prior-discussion-yes\" id=\"forminator-field-radio-2-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"prior-discussion-no\" id=\"forminator-field-radio-2-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-3-69f67d7698132-label\" class=\"forminator-label\">As a representative for the agency referring this client, I understand that, in the event of a new diagnosis of a mental health condition, or worsening of an existing mental health condition, I will be required to make alternative living arrangements for my client. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"Yes\"><input type=\"radio\" name=\"radio-3\" value=\"mental-health-precautions-yes\" id=\"forminator-field-radio-3-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69f67d7698132\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"mental-health-precautions-no\" id=\"forminator-field-radio-3-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">We won&#039;t be able to process a referral unless you agree to the terms above.<\/h2><h3 class=\"forminator-subtitle\">Please call (+44) (0)1923 777201 or\u00a0(+44) (0)7983 477819 before completing this form.<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">About the Client<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-222071__field--select-1_69f67d7698132\" id=\"forminator-form-222071__field--select-1_69f67d7698132-label\" class=\"forminator-label\">Title:<\/label><select  id=\"forminator-form-222071__field--select-1_69f67d7698132\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-222071__field--select-1_69f67d7698132-label\" aria-describedby=\"forminator-form-222071__field--select-1_69f67d7698132-description\"><option value=\"one\"  data-calculation=\"0\">Mrs<\/option><option value=\"two\"  data-calculation=\"0\">Ms<\/option><option value=\"Mx\"  data-calculation=\"0\">Mx<\/option><\/select><span id=\"forminator-form-222071__field--select-1_69f67d7698132-description\" class=\"forminator-description\">To select an option, press and hold down the box below, then move the cursor until you get to the correct option.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69f67d7698132\" id=\"forminator-field-text-10_69f67d7698132-label\" class=\"forminator-label\">Full name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-10_69f67d7698132-description\" \/><span id=\"forminator-field-text-10_69f67d7698132-description\" class=\"forminator-description\">Please enter your client&#8217;s full name.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f67d7698132\" id=\"forminator-field-email-1_69f67d7698132-label\" class=\"forminator-label\">Email address:<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69f67d7698132\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f67d7698132\" id=\"forminator-field-phone-1_69f67d7698132-label\" class=\"forminator-label\">Phone: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69f67d7698132\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" aria-describedby=\"forminator-field-phone-1_69f67d7698132-description\" \/><span id=\"forminator-field-phone-1_69f67d7698132-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_69f67d7698132-description\">Please provide a number that is safe to use for contacting your client directly.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-5\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-5-picker_69f67d7698132\" id=\"forminator-field-date-5-picker_69f67d7698132-label\" class=\"forminator-label\">Date of birth: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-5\" value=\"\" placeholder=\"\" id=\"forminator-field-date-5-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f67d7698132\" id=\"forminator-field-text-1_69f67d7698132-label\" class=\"forminator-label\">Place of birth: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-1_69f67d7698132-description\" \/><span id=\"forminator-field-text-1_69f67d7698132-description\" class=\"forminator-description\">Please write as written in official ID (e.g. passport, national identity card).<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_69f67d7698132\" id=\"forminator-field-date-3-picker_69f67d7698132-label\" class=\"forminator-label\">Arrival date in the UK: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-3-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-222071__field--select-2_69f67d7698132\" id=\"forminator-form-222071__field--select-2_69f67d7698132-label\" class=\"forminator-label\">Grounds for leave to remain in the UK:<\/label><select  id=\"forminator-form-222071__field--select-2_69f67d7698132\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-222071__field--select-2_69f67d7698132-label\" aria-describedby=\"forminator-form-222071__field--select-2_69f67d7698132-description\"><option value=\"one\"  data-calculation=\"0\">Asylum seeker<\/option><option value=\"two\"  data-calculation=\"0\">Human trafficking survivor<\/option><option value=\"Domestic-abuse-survivor\"  data-calculation=\"0\">Domestic abuse survivor<\/option><option value=\"Modern-slavery\"  data-calculation=\"0\">Modern slavery<\/option><option value=\"other-grounds-for-leave-to-remain\"  data-calculation=\"0\">Other<\/option><\/select><span id=\"forminator-form-222071__field--select-2_69f67d7698132-description\" class=\"forminator-description\">To select an option, press and hold down the box below, then move the cursor until you get to the correct option.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_69f67d7698132\" id=\"forminator-field-text-11_69f67d7698132-label\" class=\"forminator-label\">Please explain:<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69f67d7698132\" id=\"forminator-field-text-7_69f67d7698132-label\" class=\"forminator-label\">Native language: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-7_69f67d7698132-description\" \/><span id=\"forminator-field-text-7_69f67d7698132-description\" class=\"forminator-description\">Please indicate your client&#8217;s native tongue.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-4-69f67d7698132-label\" class=\"forminator-label\">English language proficiency: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-69f67d7698132\" class=\"forminator-radio\" title=\"Fluent\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Fluent<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-69f67d7698132\" class=\"forminator-radio\" title=\"Intermediate\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Intermediate<\/span><\/label><label id=\"forminator-field-radio-4-label-3\" for=\"forminator-field-radio-4-3-69f67d7698132\" class=\"forminator-radio\" title=\"Basic\"><input type=\"radio\" name=\"radio-4\" value=\"Basic\" id=\"forminator-field-radio-4-3-69f67d7698132\" aria-labelledby=\"forminator-field-radio-4-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Basic<\/span><\/label><label id=\"forminator-field-radio-4-label-4\" for=\"forminator-field-radio-4-4-69f67d7698132\" class=\"forminator-radio\" title=\"Poor\"><input type=\"radio\" name=\"radio-4\" value=\"Poor\" id=\"forminator-field-radio-4-4-69f67d7698132\" aria-labelledby=\"forminator-field-radio-4-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Poor<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69f67d7698132\" id=\"forminator-field-text-4_69f67d7698132-label\" class=\"forminator-label\">Religion:<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"\" aria-describedby=\"forminator-field-text-4_69f67d7698132-description\" \/><span id=\"forminator-field-text-4_69f67d7698132-description\" class=\"forminator-description\">Please note that we welcome guests of all faiths.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-7-69f67d7698132-label\" class=\"forminator-label\">Any children requiring accommodation? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-69f67d7698132\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-7\" value=\"children-yes\" id=\"forminator-field-radio-7-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-69f67d7698132\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"children-no\" id=\"forminator-field-radio-7-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_69f67d7698132\" id=\"forminator-field-name-4_69f67d7698132-label\" class=\"forminator-label\">Name of child 1: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_69f67d7698132\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-7\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-7-picker_69f67d7698132\" id=\"forminator-field-date-7-picker_69f67d7698132-label\" class=\"forminator-label\">Child 1 &#8211; date of birth: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-7\" value=\"\" placeholder=\"\" id=\"forminator-field-date-7-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-7\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_69f67d7698132\" id=\"forminator-field-name-7_69f67d7698132-label\" class=\"forminator-label\">Name of child 2:<\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"\" id=\"forminator-field-name-7_69f67d7698132\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-9\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-9-picker_69f67d7698132\" id=\"forminator-field-date-9-picker_69f67d7698132-label\" class=\"forminator-label\">Child 2 &#8211; date of birth:<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-9\" value=\"\" placeholder=\"\" id=\"forminator-field-date-9-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-8\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-8_69f67d7698132\" id=\"forminator-field-name-8_69f67d7698132-label\" class=\"forminator-label\">Name of child 3:<\/label><input type=\"text\" name=\"name-8\" value=\"\" placeholder=\"\" id=\"forminator-field-name-8_69f67d7698132\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"date-8\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-8-picker_69f67d7698132\" id=\"forminator-field-date-8-picker_69f67d7698132-label\" class=\"forminator-label\">Child 3 &#8211; date of birth:<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-8\" value=\"\" placeholder=\"\" id=\"forminator-field-date-8-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-10-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-10-69f67d7698132-label\" class=\"forminator-label\">Does your client have an emergency contact? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-69f67d7698132\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-10\" value=\"emergency-contact-available-yes\" id=\"forminator-field-radio-10-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-69f67d7698132\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-10\" value=\"emergency-contact-available-no\" id=\"forminator-field-radio-10-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69f67d7698132\" id=\"forminator-field-text-5_69f67d7698132-label\" class=\"forminator-label\">Name of emergency contact: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69f67d7698132\" id=\"forminator-field-text-9_69f67d7698132-label\" class=\"forminator-label\">Phone number for emergency contact: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-6-69f67d7698132-label\" class=\"forminator-label\">Any physical health conditions? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-69f67d7698132\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-6\" value=\"physical-health-conditions-yes\" id=\"forminator-field-radio-6-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-69f67d7698132\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"physical-health-conditions-no\" id=\"forminator-field-radio-6-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69f67d7698132\" id=\"forminator-field-textarea-2_69f67d7698132-label\" class=\"forminator-label\">Please list physical health conditions, along with required medication if any:<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69f67d7698132\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-8-69f67d7698132-label\"><span id=\"forminator-radiogroup-radio-8-69f67d7698132-label\" class=\"forminator-label\">Any mental health conditions? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-69f67d7698132\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-8\" value=\"mental-health-conditions-yes\" id=\"forminator-field-radio-8-1-69f67d7698132\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-69f67d7698132\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-8\" value=\"mental-health-conditions-no\" id=\"forminator-field-radio-8-2-69f67d7698132\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69f67d7698132\" id=\"forminator-field-textarea-3_69f67d7698132-label\" class=\"forminator-label\">Please list mental health conditions, along with required medication if any:<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69f67d7698132\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_69f67d7698132\" id=\"forminator-field-date-4-picker_69f67d7698132-label\" class=\"forminator-label\">Expected arrival date at the CWF: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-4-picker_69f67d7698132\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69f67d7698132\" id=\"forminator-field-textarea-4_69f67d7698132-label\" class=\"forminator-label\">Please list expected duration of stay with us; ongoing keywork being carried out on your client&#039;s behalf; and any additional\/outstanding support needs. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69f67d7698132\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12  cwf_rules_upload\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69f67d7698132\" id=\"forminator-field-upload-1_69f67d7698132-label\" class=\"forminator-label\">Please upload a copy of the house rules, signed by your client: <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_69f67d7698132\" aria-describedby=\"forminator-field-upload-1_69f67d7698132-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69f67d7698132\" class=\"forminator-input-file-required do-validate\" accept=\".avif,.heif,.heics,.heifs,.pdf\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_69f67d7698132_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_69f67d7698132\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><span id=\"forminator-field-upload-1_69f67d7698132-description\" class=\"forminator-description\">Please make sure you have discussed these rules with your client; engage an interpreter or Google Translate where necessary. We only accept PDFs.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">About Your Agency<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69f67d7698132\" id=\"forminator-field-text-8_69f67d7698132-label\" class=\"forminator-label\">Name of agency: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-8_69f67d7698132-description\" \/><span id=\"forminator-field-text-8_69f67d7698132-description\" class=\"forminator-description\">Please indicate the name of the referring agency.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_69f67d7698132\" id=\"forminator-field-name-6_69f67d7698132-label\" class=\"forminator-label\">Your full name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"\" id=\"forminator-field-name-6_69f67d7698132\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69f67d7698132\" id=\"forminator-field-text-2_69f67d7698132-label\" class=\"forminator-label\">Your role: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69f67d7698132\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-describedby=\"forminator-field-text-2_69f67d7698132-description\" \/><span id=\"forminator-field-text-2_69f67d7698132-description\" class=\"forminator-description\">Please indicate your role at the referring agency.<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69f67d7698132\" id=\"forminator-field-phone-2_69f67d7698132-label\" class=\"forminator-label\">Your phone number: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_69f67d7698132\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" 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--><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd8ff48 elementor-widget elementor-widget-html\" data-id=\"fd8ff48\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script>\n\nlet file_upload = document.querySelector(\".forminator-field-upload\");\nfile_upload.querySelector(\"label\").innerText = \"\";\nlet labelFill = document.createElement(\"span\");\nlet labelLink = document.createElement(\"a\");\nlet labelEnd = document.createElement(\"span\");\nlet labelRequired = document.createElement(\"span\");\n\nlabelFill.innerText = \"Please upload a copy of the house rules, signed by your client. 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