Young Carer Support Request

 
1 Start 2 Complete

This form requires full information about the young carer and their family, as well as consent from the parent/guardian. If you are a professional who wants to tell us about a young carer but you only have limited details, please return to the contact us page of our website and use the Provisional Support Request Form

If you have not obtained consent from the parent or guardian of the young carer, please go to our Provisional Young Carer Support Request

If you are a professional seeking support for a young carer, please select 'Professional' If you are the parent or guardian of a young carer, please select 'Self-referral', unless you are making this request on the advice of a professional, in which case please select "Professional' and add that person's details.
Professional Referrer
Please include the country code
Please include the country code and no spaces
Organisation
The name of the organisation you work for
There is space on this form for up to four Young Carers. If there are more, we will take further details from you when we speak to you. Please only give us details about Young Carers within the same family.
Young Carer
Please note we can only support young carers aged over 5 in Bradford district and aged over 7 in North Yorkshire
Fill in only if consent is given to contact this way
Fill in only if consent is given to contact this way
Further Demographics
School
Please check to see if the school is already in our database
Please put 'Home' if the young carer is home-schooled
Key contact at school
e.g. Head of Year or Form Tutor. An initial appointment with a young carer worker will be arranged and will take place in school
Cautions
Is there anything we should be aware of relating to the Young Carer's own needs (allergies, dietary or behavioural issues)? Are there any other issues for us to be aware of?
Please provide further information on any of the issues selected above
Young Carer (2)
Fill in only if consent is given to contact this way
Fill in only if consent is given to contact this way
Further Demographics
School
Please check to see if the school is already in our database
Please put 'Home' if the young carer is home-schooled
Key contact at school (Young Carer 2)
Cautions
Is there anything we should be aware of relating to the Young Carer's own needs (allergies, dietary or behavioural issues)? Are there any other issues for us to be aware of?
Young Carer (3)
Fill in only if consent is given to contact this way
Fill in only if consent is given to contact this way
Further Demographics
School (Young Carer 3)
Please check to see if the school is already in our database
Please put 'Home' if the young carer is home-schooled
Key contact at school (Young Carer 3)
Cautions
Is there anything we should be aware of relating to the Young Carer's own needs (allergies, dietary or behavioural issues)? Are there any other issues for us to be aware of?
Young Carer (4)
Fill in only if consent is given to contact this way
Fill in only if consent is given to contact this way
Further Demographics
School (Young Carer 4)
Please check to see if the school is already in our database
Please put 'Home' if the young carer is home-schooled
Key contact at school (Young Carer 4)
Cautions
Is there anything we should be aware of relating to the Young Carer's own needs (allergies, dietary or behavioural issues)? Are there any other issues for us to be aware of?
Parent/Guardian
Fill in only if consent is given to contact this way
Fill in only if consent is given to contact this way
Please tick if the parent/guardian is also a carer
There is space on this form for up to four cared-for people. If there are more, we will take further details from you when we speak to you.
Cared-for person (1)
e.g. Sam [Cared For] is the Parent of Billie [Young Carer] so choose 'Parent of / Step Parent of'
Condition/s of the person being cared for
Please tick as many as appropriate and sub-options will appear
Cared-for person (2)
e.g. Sam [Cared For] is the Parent of Billie [Young Carer]
Condition/s of the person being cared for
Please tick as many as appropriate and sub-options will appear
Cared-for person (3)
e.g. Sam [Cared For] is the Parent of Billie [Young Carer]
Condition/s of the person being cared for
Please tick as many as appropriate and sub-options will appear
Cared-for person (4)
e.g. Sam [Cared For] is the Parent of Billie [Young Carer]
Condition/s of the person being cared for
Please tick as many as appropriate and sub-options will appear