Welcome to the application form for the Region of Waterloo's Home Audit program.

Please complete this application if you are interested in receiving a free in-home water audit.

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.

As part of the review, the Region of Waterloo's partner, Reep Green Solutions, 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 audit. Upon review of your application, a representative from Reep Green Solutions will 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

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

How did you hear about the program?

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 audit

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

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

Are you interested in learning about the Region's other FREE 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 Challenge Program and to monitor water savings. Any questions regarding the collection of this personal information should be directed to Steve Gombos, Manager of Water Efficiency at sgombos@regionofwaterloo.ca or 519-575-4400 ext. 4503.

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

Yes

Please sign your name.

Clear