Kirklees and Calderdale Care Association
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KirCCA MEMBERSHIP FORM 2024/25
Please enter the name of your business.
(If applicable)
Please enter the name of your business.
Select Type of Service (tick all that apply)
Care Home
Care Home with Nursing
Domiciliary Care
Extra Care
Supported Living
Other community based service
Client Group (tick all that apply)
Over 65’s
Dementia
Physical Disabilities
Mental Health
Under 65’s
Under 18’s
Sensory Impairment
Learning Disabilities
Palliative Care
Drug Dependence
Please enter your client group.
Local Authority area you operate in:
Please select
Kirklees
Calderdale
Both
Please enter your local authority.
CONTACT DETAILS (Provider Level – Director, Regional or Senior Manager)
Please enter contact name.
Please enter role.
Please enter address.
Please enter postcode.
Please enter address.
CONTACT DETAILS (Registered Managers)
Service/Care Home Name
Contact Name
Email Address
Telephone
INFORMATION REQUIRED – This information will remain confidential and will not be shared.
Total Number of Beds: (If applicable)
Please enter number of beds.
Total Number of Employees:
Please enter number of employees.
Total Number of Hours of Home Care/Support Per Week: (If applicable)
AUTHORISED SIGNATURE.
Signed by:
Please enter name of person signing.
Position:
Date:
KIRKLEES AND CALDERDALE CARE ASSOCIATION (KirCCA) - MEMBERSHIP INFORMATION
Membership Fees 2024/25 - No cost for members
Membership Fees 2025/26 - To be agreed
By joining as a member of KirCCA, you are agreeing to our
privacy policy.
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