COUCH Rental Application
All rentals are made without regard to race, color, religion, sex, age, ancestry, marital or familial status, physical or mental handicap, national origin, or sexual orientation. Feel free to answer "NA" or provide more information at the end of the survey about your answers. Answers are confidential within COUCH.
Full Legal Name *
Your answer
Preferred Gender Pronouns (He, She, They, Ze, etc.) *
Your answer
Preferred Email *
Your answer
Cell Phone Number *
Your answer
Address *
Your answer
Previous Addresses and When *
Your answer
Emergency Contact Info (Name, Relationship, Phone, Email, and Address) *
Your answer
Personal Reference (previous or current roommate, friend, parent, legal guardian, etc.) (Name of Individual, Relationship, Phone Number) *
Your answer
Rental or Employment Reference (Name of Individual, Company Name, Relationship, Phone Number) *
Your answer
How long have you known your rental or employment reference, and when were your dates of rental or employment? *
Your answer
Have you ever caused any legal issues involving physical violence or weapons? *
Your answer
I understand and agree that my membership is automatically terminated for dealing drugs or becoming physically violent in Brooks or Harvest House. *
I agree to protect all members’ health and safety in the house (e.g. no guns, smoking, fire hazards, etc.). *
I will contribute at least 6 hours per week of labor (cooking/cleaning, responsibilities, workdays, meetings) to Brooks or Harvest House. *
Will you be able to pay a security deposit (one month’s rent) the same day you sign a contract? *
Will you be able to pay one month’s rent plus food/utilities the same day you move into Brooks or Harvest House? *
Will you sign a full year lease through August 15? *
How many years would you like to stay at Brooks or Harvest House? *
Your answer
Have you ever broken a lease or been evicted? *
Do you have renter's insurance? (Not required) *
Do you have any allergies or dietary restrictions? *
Your answer
Do you have any pets? If yes, please list the type of animal, name, and size. *
Your answer
Do you take any medications that you would like the house to be aware of? *
Your answer
Do you have any other special needs that you would like the house to be aware of? *
Your answer
Comments:
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms