Young Carer New Professional Support Requests

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Privacy Notice

Before you proceed, we would like to draw your attention to our Privacy Notice.

Your privacy and data protection are of utmost importance to us, and we want to ensure that you are fully informed about how we collect, use and protect your personal information.

Please take a moment to review our privacy notice.

Privacy Policy

Please confirm the following:

I have obtained express consent from the parent/guardian of the young carer being referred to provide all of the information required and request support from Carers Resource.

Yes

We require you to speak to the speak to the Young Carer’s parent/guardian before making this referral, to gain their permission to refer them to the Young Carer service.

Professionals Details

First Name

Last Name

Job Title

Phone Number

Mobile Number

Young Carer

First Name

Last Name

Street Address

Street Address Line 2

City

Postcode

Phone Number

Mobile Number

Date of birth

Gender

Female

Male

Non-binary

Other

Prefer not to say

Other Gender

Is the gender the young carer identifies with the same as their sex registered at birth?

Ethnicity

Other Ethnicity

Sexuality

Religion

Other Contact Information

Do you consider the young carer to have a disability?

Is their disability substantial and/or long term?

Substantial

Long-term

Details of their disability

What is the main language of the young carer?

Other Language

Country of Origin

Do any of the following apply to the young carer?

Caution Category

Caution Notes

School/College attended by the young carer

Please select the school from the box below. If it does not appear please type the school name into the box provided

Organization Name

Type of Organization

Education - Primary

Education - Secondary

Education - Further

Education - Special needs

Postal Code

Key school contact for the young carer

Job Title

First Name

Last Name

Parent or Guardian

First Name

Last Name

Gender

Female

Male

Non-binary

Other

Prefer not to say

Date of birth

Does the parent/guardian share the young carers address?

Yes

Street Address

Street Address Line 2

City

Postcode

Phone Number

Mobile Number

Cared For

First Name

Date of birth

Postcode

What is the carers relationship to the person they care for?

The cared for is the child of the young carer

The cared for is the parent of the young carer

The cared for is the spouse of the young carer

The cared for is the partner of the young carer

The cared for is the sibling of the young carer

The cared for is the grandchild of the young carer

The cared for is the grandparent of the young carer

The cared for is the niece or nephew of the young carer

The cared for is the aunt/uncle of the young carer

Condition

To select multiple conditions:

Click and hold the Left Mouse button and drag to select multipleOr
Hold the CRTL key and Left Mouse button click to select multiple option

Details

Brief Details of support required by the Young Carer

Please select the local team for the young carer from the dropdown below

Support Request Reference ID

Brief details of support required by the young carer

Is the young carer new to caring?

Last Name

Assign To

Relationship to Young Carer Start Date

Start Date 6

Relationship to Young Carer Start Date

Activity Subject

Activity Date

All Services - Service

All Services - Where did you hear about us?

All Services - Source

Start Date 4

Contact Method

Young Carer New Professional Support Requests

Privacy Notice

Before you proceed, we would like to draw your attention to our Privacy Notice.

Your privacy and data protection are of utmost importance to us, and we want to ensure that you are fully informed about how we collect, use and protect your personal information.

Please take a moment to review our privacy notice.

Privacy Policy

I have obtained express consent from the parent/guardian of the young carer being referred to provide all of the information required and request support from Carers Resource.

We require you to speak to the speak to the Young Carer’s parent/guardian before making this referral, to gain their permission to refer them to the Young Carer service.

Professionals Details

Professionals Organisation

Young Carer

Do any of the following apply to the young carer?

School/College attended by the young carer

Key school contact for the young carer

Parent or Guardian

Cared For

Brief Details of support required by the Young Carer

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Young Carer New Professional Support Requests

Privacy Notice

Before you proceed, we would like to draw your attention to our Privacy Notice.

Your privacy and data protection are of utmost importance to us, and we want to ensure that you are fully informed about how we collect, use and protect your personal information.

Please take a moment to review our privacy notice.

Privacy Policy

I have obtained express consent from the parent/guardian of the young carer being referred to provide all of the information required and request support from Carers Resource.

Status message

We require you to speak to the speak to the Young Carer’s parent/guardian before making this referral, to gain their permission to refer them to the Young Carer service.

Professionals Details

Professionals Organisation

Young Carer

Do any of the following apply to the young carer?

School/College attended by the young carer

Key school contact for the young carer

Parent or Guardian

Cared For

Brief Details of support required by the Young Carer

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