Young Carers Referral

Details of Young Person
 
 
 
 

Parent/Guardian

 
 
 
 
 
Family Details
 
 
 
 

Please state below the nature of illness, disability or condition of cared for person(s):

 
 
 
Young Person"s Additional Information

Does the young person have any additional support needs?

 
Young Person"s Caring Role (Reason for referral):

Is the young person the main carer or a secondary carer?

Please give a brief description of the young person"s caring role (i.e. physical or emotional caring responsibilities).

Please give a brief description of the impact the caring responsibilities have on the young person?

What would be the desired outcomes for the young person as a result of accessing The Young Carers Service?

 
Other Services working with the family:
 
 
 
Referral agents details
 
 
 
 

In order for this referral to be processed a parent or guardian must have consented to the referral being made to The Young Carers Service.

 

Young Carers Referral Form

Tel: 01738 567076
Fax: 01738 440717

Definition of a Young Carer:

A young carer is child or young person between the ages of 5-16 who provides care or assistance to a family member of any age, due to a disability, mental health issues, chronic / terminal illness or problems relating to substance or alcohol misuse. Young carers often taken on responsibilities which would normally be associated with that of an adult.