Young Carer Registration Form for parents or guardians

Notice

If you have any questions or would like to speak to a Young Carers Support Worker before completing this form, please contact the team on 020 8867 2383 or email youngcarers@richmondcarers.org

GDPR consent

The information you provide will be recorded on our contact management system and will be managed within the principles of the General Data Protection Regulations 2018. We require your consent to hold information you provide and to ensure you regularly receive our communication bulletins. You can read Richmond Carers Centre's privacy policy here

GDPR Agreement *

I consent to having this website store my submitted information so Richmond Carers Centre can process my registration with their services.

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Young carer's contact details

Young carer's pronouns

Young carer's name *

First

Last

Young carer's address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Young carer's email

Not mandatory

Young carer's mobile

Not mandatory

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Parent/Guardian's contact details

Parent/Guardian's name *

First

Last

Parent/Guardian's email *

Parent/Guardian's mobile *

Emergency contact's details

This should be different from the Parent/Guardian's contact details above

Emergency contact's name *

First

Last

Emergency contact's mobile *

Emergency contact's relation to the young carer *

e.g. family member, neighbour, family friend

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Information about the young carer

Young carer's date of birth *

Young carer's gender *

Please specify *

Young carer's religious group *

Please specify *

Ethnic Group *

Please specify

Does the young carer have a disability? *

Please specify *

Does the young carer have an Education and Health Care Plan? *

Please specify *

Does the young carer or your family receive any of the following support? *

Early Help Service
Social Worker
CAMHS
Other
No

Please specify *

Is the young carer or your family subject to an Early Help Assessment? *

Please specify *

Is the young carer or your family subject to a Child in Need or Child Protection Plan? *

Please specify *

Which school or college does the young carer attend? *

Does their school/college know that they are a young carer? *

Do you give us permission to contact school and other professionals supporting you to share or request information from them? *

Medical emergencies

In an emergency, we will ensure the young carer receives medical treatment as appropriate to his/her/their needs, including hospitalisation if necessary. You will be contacted as soon as is practically possible. Therefore, please ensure you have provided a reliable emergency contact for the young carer.

Does the young carer have any medical conditions? *

Please specify *

Does the young carer take any medication? *

Please specify *

Will they require this medication on trips? *

Please specify *

Does the young carer have any allergies? *

Please specify *

Does the young carer have any dietary requirements? *

Please specify *

Does the young carer have any challenging behaviour? *

Please specify *

Are there any situations or scenarios where your child may require additional support? *

Please specify *

Does the young carer suffer from travel sickness? *

Please specify *

Photo/video consent

Richmond Carers Centre uses photos and video images of young carers registered with Richmond Carers Centre for the promotion of services for young carers in the London Borough of Richmond upon Thames. Examples of usage include the Richmond Carers Centre website, blog posts, promotional videos following events for young carers to be shared on social media and other digital channels, and in digital communications. Images are powerful promotional tools and make a huge difference to the impact we can achieve when championing young carers in Richmond.

I GIVE CONSENT for the young carer to appear in photographs and video footage taken and stored by Richmond Carers Centre during activities, breaks and trips for young carers. *

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Information about the person/people being cared for

Name of the person being cared for *

First

Last

Date of birth *

What is their main illness, disability or condition? *

Do they live with you? *

Do they live in the London Borough of Richmond upon Thames? *

If no, please provide their postcode?

Who else is providing care and support to the person being cared for? *

Paid care workers
Other professional care workers
Other family members over 18 years of age
Other family members under 18 years of age
Other non-family members
Nobody else is providing care

Please tick all the appropriate boxes that apply

Refer another unpaid carer to Richmond Carers Centre

If the other person providing care is an unpaid carer / young carer, you can refer them to Richmond Carers Centre using one of our online referral forms here.

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How can we help you?

Our young carer support service includes information and advice, emotional support, mentoring service, after school groups, holiday activity programmes, careers advice and bespoke events.

We send regular service and information updates to young carers and parent/guardians via email. If you would like to receive information about Richmond Carers Centre’s services, please provide your consent: *

On submission of this form you are registering with Richmond Carers Centre – Young Carers Service.

Please inform us if there are any changes to your caring role or if your caring role ceases and you no longer require access to our services.

Name of the person submitting this form *

First

Last

Date *

Young Carer Registration Form for parents or guardians

Notice

GDPR consent

Young carer's contact details

Parent/Guardian's contact details

Emergency contact's details

Information about the young carer

Medical emergencies

Photo/video consent

Information about the person/people being cared for

Refer another unpaid carer to Richmond Carers Centre

How can we help you?

Disclaimer

Contact our support team on 020 8867 2380