Name :ppppppppppppppp Contact number:

Address:

City/State: Postcode:

Email :pppppppppppppp

Sex : Male Female Marital Status: Married Partnered Single Special Needs: None Indigenous Disability

House location preferred : Augusta Australind Balingup Boyup Brook Bridgetown Bunbury Busselton Capel Collie Dalyelup Dardanup Donnybrook Dunsborough Eaton Greenbushes Harvey Manjimup Margaret River Nannup Northcliffe Pemberton Walpole Number of rooms required required: 1 2 3

Number dependent children: 0 1 2 3 4

References (If you have no referees, just type "none" in the first "Name" field)

1 - Name: Contact Number:
2 - Name: Contact Number:
3 - Name: Contact Number:
4 - Name: Contact Number:

Form action to be taken
Add name to boarder list Remove name from list

By clicking "send" you are consenting to this information being released to landlords registered with the Bunbury Housing Association. This information will not be released to anyone else unless there is a legal necessity to do so.

PLEASE NOTE

Some landlords may require prospective boarders to provide an up to date NATIONAL POLICE CLEARANCE before agreeing to a placement. It is recommended that people registering for accommodation apply for such a clearance for themselves and any other adult included in their registration.

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Bunbury Housing Association retains the right to cancel the registration of any participant without notice and for any reason it deems appropriate.