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Alexa Application Form
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* Indicates required question
Your Name
*
Your answer
Your Email address (only to be used for contacting you about the Alexa devices)
*
Your answer
Your Phone number (only to be used for contacting you about the Alexa devices)
*
Your answer
Name of care home
*
Your answer
Is the care home:
*
N.B. we can send the devices nationally, this question is just for internal logistics
in a London Borough?
on the Isle of Wight?
Elsewhere
Are you:
*
a relative/friend of a care home resident?
a care home member of staff / manager / director?
Other:
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