Healing Households Village Services Form
Support for Single Parents!
The old saying is true, it takes a Village to raise a child. Are you a business owner or skilled professional? Are you willing to volunteer time to provide your service or skill to single parents and/or their children? Whether you're a barber, beautician, masseuse, mechanic, doctor, babysitter, therapist, dentist, etc. we need your support! Please fill out this short form, and someone from the House will reach out to you with next steps.
Note: You must complete and sign a Village Partner Agreement before any service is performed. Once we get your information, we will add you to our database of Village partners. Once notified by a parent/ child in need of self-care or a service you provide, we will contact you to check your availability and capacity. After we hear back, we will schedule a time to connect the two of you.
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1.
What is your First and Last name?
(Required.)
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2.
What is your email address?
(Required.)
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3.
What is the best contact number for you?
(Required.)
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4.
What is the name of your Business or Occupation?
(Required.)
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5.
Where is your Business/Occupation located? (City, State)
(Required.)
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6.
Which best categorizes your service?
(Required.)
Therapy/Counseling
Child-Care Services
Health/Medical
Legal Support
Beauty/ Cosmetics
Auto/Mechanics
Travel/Hospitality
Other (please specify)
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7.
How often are you willing to provide this service?
(Required.)
Once
Weekly
Monthly
Annually
Upon Request
Other (please specify)
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8.
Please provide your Business website, Business Instagram Handle, or Business Facebook Name below.
(Required.)
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9.
Does Healing Households have permission to feature you on our website and social media pages?
(Required.)
Yes, you have my permission
No, I would like my actions to remain anonymous