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Parent and guardian young carer referral form

Please use this form if you are the parent / guardian of a young carer aged 5+ in Medway or aged 16-17 in Lincolnshire.

Please ensure you discuss this referral with the young person. In our experience young people who are unaware of the referral often will not engage with our service. As this service is child focused it is important that the young person understands why they are being referred. Young carers aged 13 or over are able to consent themselves. 

Please provide us with as much information within each of the boxes as possible.

Complete form

Select your local service
Your details
Young carer details
Please indicate if home schooled or does not attend school
Carer's level of care provided each week Please include any emotional support as well as helping at home, preparing meals etc.
Does the carer have any needs of their own?
Please provide details inc any named keyworkers and contact details:
By family we mean anyone who lives with the young carer or who helps with their support. Please provide: a) name, b) relationship to young person, c) indicate if they live with the young carer
If 13+ please ensure young carer's contact details are provided
If 13+ please ensure young carer's contact details are provided
Preferred contact method
Times to avoid making contact
Parent guardian preferred contact method
What support is the young carer interested in?
Or, tell us anything else about the young person which may be useful in order to provide appropriate support
Please ensure the young carer consents to the referral.
Please note if the young carer is aged under 13 years old consent is also required by parent / legal guardian before a referral can be accepted