Form _ Young carer self referral

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Important - please read carefully

This form is for use by young carers up to the age of 18 who wish to register, and receive support from, Carers Link. If necessary you can ask an adult to help you complete the form. If you are under the age of 13, your parent or guardian will need to sign the form on your behalf.

1. About you

2. About your caring

Please tell us who you care for and why. If you care for more than one person, please tell us about the person you care for most, or whose caring causes the most issues. We will then get details of the other person/ people when we speak to you
Do they live with you?

3. Please tell us how you are coping in your caring role.

I am coping well
I am just managing
I am struggling
I am at crisis point

4. Some important stuff we need to tell you.

Your consent to store

Carers Link requires your consent to store your information. We do this so that we can communicate with you about activities and services that may be of interest. We also store information so that you do not have to repeat your story each time you contact us, and so that we can properly advocate on your behalf or provide any support for your caring role. For this reason, we also collect some information about the person you care for and we seek your permission, on their behalf, to store this information. All information is restricted in access (need to know) and held securely in a treble password-protected database. We will never, ever, sell your details to another agency, and we will only ever share your information with your permission unless required to do so by law. Only anonymised data is used for statistical monitoring. You can read our full Privacy Policy at https://carerslink.org.uk/download/privacy-policy-for-carers/. Any updates or changes to the policy are announced via our newsletters.

This section only applies if you think you will require advocacy support which could include contacting the school, council, social work or any other agency on your behalf.

We will check with you each time you ask us to make a new referral and seek your verbal, written or text consent depending on the level of information that you require us to share. We will only ever share information without your consent if we believe there is a risk of harm to a child or vulnerable adult.

Time to sign the form

We now need either you, or your parent or guardian, to sign the form to confirm that you give consent for your information to be stored as detailed above. Please choose the appropriate option for your age.

I am aged 13 - 17 and give consent for my information to be stored. I have discussed this with my parent/ Guardian

This young carer is under the age of 13. I, as the parent or guardian, give consent for their information to be stored.

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