Join a network near you - FitzRoy

Join a network near you

Fill in our form below and a member of our Love4Life team will be in touch.


Friendship and Dating Application Form
  • Your details

  • Please provide a secondary number of someone we can contact if we cannot get hold of you.
  • More about you

  • Max. file size: 64 MB.
  • ie do you use a wheelchair or have difficulty with stairs?
  • ie sign language, Makaton, understanding other people
  • ie epilepsy, anxiety
  • You can select more than one.
  • Reference request

    To become a member of Love4Life, you are required to provide a reference from someone who knows you in a professional manner. This could be a social worker, a college lecturer, your GP, an employer, or your support worker. We will ask them to confirm that you are who you say you are, that you have a disability, and that, to the best of their knowledge, you have no criminal convictions or cautions. Please provide the details of this person below.
  • I give my consent for FitzRoy and Love4Life to keep my information while I am applying to be a member and for as long as I am a member of Love4Life.
  • Love4life will keep this information while your application is being processed and as long as you are a member of Love4life. Love4Life will retain your information for up to 12 months after you choose to leave Love4Life and will write to you to confirm the cancellation of your membership and invite you to provide feedback on why you've chosen to leave Love4Life. If your application is unsuccessful, your details will be destroyed.