Carer's Registration Form

Barnet Carers is a leading charity offering advice, information, emotional and practical support for all informal carers who live or work in the London Borough of Barnet.

The Adult Carers Team assists carers over the age of 18 by providing a range of services such as Carer's Assessments, Counselling, peer support groups, regular support calls, training, and more.

The Young Carers Team helps carers from the age of 5 to 17. Young people can access support in schools, mentoring, tutoring and benefit from activities led by partners from different organizations across the Borough.

If you, or someone you know, might benefit from our help and support don’t hesitate to contact us. We are here to help.

Title

How do you like to be addressed.

First Name

Last Name

This is your last or family name.

How would you like us to address you?

How would you like us to address you. This could be the name you are used to or whether you would prefer us to be more formal.

Date of birth

Don't worry, we will not be sharing your age with anyone, we just need it for our records and to make sure that we are providing you with appropriate information.

Address

Address Line 1

Address Line 2

City

State or Region

Country

Post Code

Phone Number

Mobile Number

Your email, that will be included in our mailing list.

Gender

We take note of the gender of the people we offer Carers Assessments so that we can make sure that we are being fair and respecting people's identities.

Religion

What is your preferred language?

We will try and get someone to speak to you who can speak your language. This is not always possible and if necessary we will organise for an interpreter.

Do you need an interpreter?

Average hours of caring per week:

How many hours per week do you spend in your caring role?

Now we are going to ask you some questions about the person you care for. This is so that we can get a good idea of the care you are offering and can make sure that your carers action plan fits you as well as it can.

Title of the person you care for

First name of the person you care for

Last name of the person you care for

Address of the person you care for

Address Line 1

Address Line 2

City

State or Region

Zip

Cared for date of birth

Gender of person you care for

We take note of the gender of the people we offer Carers Needs Assessments to so that we can make sure that we are being fair and providing services to all who need them,

What is your relationship to the person you care for?

How did you hear about Barnet Carers?

For example, your GP, Social Worker, other charitable organizations, friends, online research...

I give consent for my details to be held on Database

Please confirm that you have given consent for the information provided on this form to be securely and confidentially stored on our database.

Admin^*

Don't worry about this field! This is just the admin email.

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