Carer support requests and registration

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Please complete this form if you are a carer and you want information or support for your caring role. If you have not yet registered with Carers' Resource, the information you provide on this form will be used to register you with us.

If you are filling in this form on behalf of someone else, and you have their permission to do so, please complete the form with their details.

Young carers, aged under 18, should instead complete our Young Carer form.

For general enquiries, not to do with caring, please email info@carersresource.org

We also have an online form that professionals working with carers can use to refer a client for our services.

Data Agreement

By ticking the box below you agree that Carers' Resource may securely store the information you have supplied in this form in line with our Privacy Policy. If you do not want us to store your data you will not be able to submit this form and will have to contact us by phone instead. We will not share your details without permission.

Data Agreement *

I agree that Carers' Resource may securely store my personal information in line with their privacy policy.

Your contact details

Title

First Name *

Last Name *

Email *

An email is required in order for us to process this form

Phone number

Please give the phone number it is best to call you on. For example, this could be your home landline number, or your mobile number.

Alternative phone number

If you have another phone number we can try to reach you on, if we can't contact you by your main phone number, please provide it here.

Best time to phone

We will try to get in touch with you at your preferred time if possible, but may call at other times.

Street Address

Street Address Line 2

City/town/village

Postcode *

We need at least a postcode to be able to deal with your enquiry effectively.

Country

County

Date of birth

Date of Birth

Day

Month

Year

Leave this field blank

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Carer support requests and registration