an older adult with a young carer laughing

Overview

Join The Carers Information Service

Complete this form to register with our Carers Information Service.

If you are already registered with us, and your Carers Card has expired, you do not need to complete this form again. Please fill out this online application form here to receive your new card. If you need any help, or a reminder of what your unique Carer ID number is, please get in touch.

About You

Title (required)

First name (required)

Last name (required)

Date of birth (required)

Gender (required)

Address (required)

Town (required)

Postcode (required)

Daytime phone number (required)

Mobile phone number

Email (please provide your email address if you are happy to receive information by email)

Education and employment (required)

If you selected "Other" please describe here

Ethnicity (required)

If you selected "Other" please describe here

Does your GP surgery know you are a carer?

Some GP surgeries offer priority appointments andother carers support

Are you on the carers register at your GP surgery (required)

If no / don't know, would you be happy for us to let your GP surgery know that you are a carer?

About The Person You Support

Please tell us about the person you support. If you support two people, please give us the second person's details on the next page. If you support more than two people, please complete the form only for the two people that need the most care.

Date of birth (required)

What is your relationship to the person you support (for example are you their husband, daughter, neighbour) (required)

Please tell us which town the person you support lives in (required)

Does the person you support live with you? (required)

Please describe the needs of the person you support (tick all that apply) (required)

Other (please describe in box below)

Other

Ethnicity of the person you support (required)

Other

Do you support another person? (required)

Other Information

How did you find out about the Carers Information Service?

If you selected 'other' or want to tell us more about how you found out about the Carers Information Service, please tell us here

Any personal information you provide us with, will be held and used in accordance with the Data Protection Act 2018. If you would like to find out more information about how we will use your information, please see our Privacy Notice here: crispweb.org/privacy-notice.aspx (required)

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