Homeless Client Accommodation and Needs Registration form

Homeless Client Accommodation and Needs Registration form

New Homeless Clients are required to complete the relevant permission forms in order to access my help and assistance. These are comprehensive in I capture vital information which I will then use when challenging decisions or advocating with the various decision makers. 

Please ensure you complete the Registration form, I aim to reply that same day, often within a few hours from receipt of the permission forms. 

The New Client Survey is also an additional tool, I recommend new Clients complete as this again delves deeper into your homeless journey from past, present to future. The vital medical questions are fully confidential, but again can be used to measure the impact poor quality housing of your homeless issue is having on you mentally speaking. Please do try and complete both. 

Thank You

Daniel Harris 

New Client Registration Form

*Must Complete if require more help.

Thank you for contacting me with your housing/homelessness advocacy issue. In order to effectively advocate for you, I will need you to complete the following form and confirm at the end of the statement to advocate for and on your behalf. I will not be able to assist clients unless this form is completed and submitted to me.

Your Home



Do you take any medications and/or treatments: if so please list below along with any side effects?

Thank you for for completing that info. Please now confirm you are happy for me Daniel Harris to advocate for you and on your behalf by Signing your full name in the text box and Selecting the "Yes" Box in the Checkbox below and then submit the form to myself.

Hi Dan hope ur good I got my keys now whoop whoop and will be moving in Sunday I also wanted say this wouldn't off happened had I not reach out for help and what you done for me and for everyone in the community is above and beyond and it's such a blessing we have people like you to help give people a voice. You gave me back my hope and faith that life can be better so thank you so much for all you done x


LGBTQ+ Client

Take Part in My Homeless Survey Thank you!

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