Care place application form

Martha Trust cares for people with profound physical and multiple learning disabilities. We provide residential and respite care (our respite care is temporarily unavailable) in purpose-built ‘family’ homes that offer the highest standards of nursing care and state-of-the-art facilities. To register your interest in a care place with Martha Trust, simply complete the form below.

Details of person requiring care

Title[group othertitle][/group]

First name*

Surname*

Address line 1*

Address line 2

Town/City*

County*

Post code*

Country*

Details of person enquiring

Title[group othertitle2][/group]

First name*

Surname*

Address line 1*

Address line 2

Town/City*

County*

Post code*

Country*

Email*

Confirm email*

Telephone*

Martha Trust would like to keep you updated on our future news, fundraising activities and ways to support us. To opt in to receiving information from Martha Trust, please tick how you would prefer to be contacted:

EmailTelephoneLetter

or email fundraising@marthatrust.org.uk.

We do not sell or swap your details with any third parties, but in order to carry out our work we may need to pass your details on to services companies authorised to act on our behalf.

Next of kin details (if not as above)

Title[group othertitle3][/group]

First name

Surname

Address line 1

Address line 2

Town/City

County

Post code

Country

Confirm email

Telephone

Care manager details (if not as above)

Title[group othertitle4][/group]

First name

Surname

Address line 1

Address line 2

Town/City

County

Post code

Country

Email*

Confirm email

Telephone

Any other information that you think will help with your enquiry

Preferred location*Martha House, DealFrances House, DealMary House, Hastings

Type of care required*Residential

Disabilities of person seeking a place

What we do

Get in touch today

Martha Trust, Homemead Lane, Hacklinge, Deal, Kent CT14 0PG

01304 615223

Send us an email