QHome

Become a Member

Become a Member

    Membership Form

    Thank you for your interest in being a member, hereafter mentioned as “member or donator,” for Qhome. This form is used to collect information about potential members and is used for internal purposes only. The information you provide here will be kept confidential. Please note completion of membership form does not constitute membership unless you receive the acceptance email from Qhome.

    Customer Details
    Health & Medical Information

    Allergies

    Medication

    List any surgeries, common sicknesses, etc.

    Preferences & Lifestyle

    Your Preferences on Activities

    YESNO
    YESNO
    YESNO
    YESNO

    Useful Information to Know You Better

    HighMediumLow
    HighMediumLow
    non-vegetarianMostly vegetarianVegetarianVegan
    BreakfastLunchDinner
    YesNo
    WarmCold
    VigorousModerateLightNone
    YesNo
    YesNo
    YesNo
    Member Consent

    By submitting this form, I acknowledge, agree, and authorize the following:

    • The information provided is accurate and up-to-date.
    • I understand Qhome’s privacy policy, terms & conditions and all disclosure and disclaimer statements published on www.qhome.com.lk
    • I agree that I have the freedom to decide to make a donation to any worthy cause organized, involved or operated by Qhome
    • I agree to receive communication via phone, email, or other channels.