Region of Waterloo Form

Home/Living Here/Environmental Sustainability/Conserving Water

Required fields are marked with asterisks (*)

WET Home Water Review Program Application

Please complete this application if you are interested in receiving a free in-home review of your water use.

Single family homes using more than the average water use of 150 litres per person per day or 4.5m³ per person per month will qualify for a water use review free of charge. There is no water consumption minimum requirement if you are registering in the Region's Water Softener Plumbing Rebate Program.

As part of the review, the Region of Waterloo's partner, Greenbrain, will evaluate your household's water efficiency and check for possible fixture leaks and related water issues. You will be provided with a report following the visit.

Please note that by completing this application you are not committing to having a water review. A representative will review your application and then contact you to schedule your visit.

Applicant Information

Please complete this section with your contact information.

First Name

Last Name

Preferred Phone Number (mobile or landline)

Email Address

Please provide your preferred contact method in case we need more information.

Phone

Please indicate if you have preferred day of the week for your review.

Monday

Tuesday

Wednesday

Thursday

Friday

House Information

Please complete this section with information about the property.

Address Number

Address Street Name

Unit number

City/ Town

Postal Code

Are you the property owner?

Yes

Is this application for a single family home or a multi-unit residential building?

Single family home

Multi-residential unit Building

Household Water Use Information

Please complete the information in this section regarding your household water use.

Program Information

Why are you interested in having a home water review? Please select up to 2 responses.

High water bills

My household is using more than the Region’s average water use

I would like to sign up for the Water Softener Plumbing Rebate with my home water review

I think I have a water leak

I am concerned my water meter is not working

I want to reduce my environmental footprint

Other

Are you interested in learning more or registering for the Region's Water Softener Plumbing Rebate program

Yes, I'd like to learn more about the Water Softener Plumbing Rebate program during the home visit

Yes, I'd like to register for the Water Softener Plumbing Rebate program during my home visit

No, I am not interested in the Water Softener Plumbing Rebate program

Are you interested in learning about the Region's other Water Efficiency programs to save water and money in your home and/or business?

Yes

Notice of Collection of Personal Information

To the extent that the foregoing information constitutes personal information as defined in the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, chapter M.56 as amended, the information is subject to provisions of that Act and will be used to collect information for the purpose of the Region of Waterloo's WET Home Water Review Program and to monitor water savings. Any questions regarding the collection of this personal information should be directed to Dan Meagher, Supervisor of Communications & Source Water Protection Program, at dmeagher@regionofwaterloo.ca or 519-575-4400 ext. 4423.

I have read and understood the above notice of collection of my personal information.

Yes

Please sign your name.

Clear