Register As A Young Adult Carer

A young adult carer is someone aged 16-25 who cares for a family member due to disability, illness, long-term condition, poor mental health and/or addiction. Are you a young adult carer or working with someone who is? If so, Carers Bucks can support you.

Complete the registration form below to register/refer into Carers Bucks. Once received a Support Workers will make contact to organise an opportunity to discuss through the caring role in further detail. The Support Worker will work to understand and tailor the best level of support.

Please add any information that you feel is relevant for us to know in regards to the caring role.

For information on how Carers Bucks stores and uses your personal data, please see our Privacy Notice.

    Are you a young adult carer or a professional making a referral? (required)

    YOUNG ADULT CARER’S DETAILS

    First name (required)

    Last name (required)

    Gender

    Is your gender identity the same as it was given at birth?

    Sexual Orientation

    Ethnicity

    School/Educational Institute

    GP Surgery

    Disability (if any)

    House name/no. (required)

    Street (required)

    Postcode (required)

    Your email address (required)

    Phone number (required)

    Date of birth (required)

    Age (required)

    If you are aged 16-17, you will need permission from your parent/guardian to register with our services. Please ask your parent/guardian to complete this additional section with their information.

    Parent/Guardian name

    Parent/Guardian’s phone number

    Parent/Guardian’s email address

    I consent for my child to access support from Carers Bucks (required)
    Yes

    CARED FOR’S DETAILS

    Name of person being cared for (required)

    Date of birth (required)

    Relationship to young adult carer (required)

    Medical condition/disability (required)
    Please state clear diagnosis.

    Further information request
    Please add any information that you feel is relevant for us to know in regards to your caring role.

    How did you hear about Carers Bucks? (required)

    PROFESSIONAL’S REFERRAL

    Carers Bucks relies on voluntary participation. We are only able to accept referrals which the young person and or family/guardian has consented to and are willing to engage with our services. Carers Bucks complies with current Data Protection legislation. This form and the information it holds will be transferred to our secure database, along with all records of any work we do with you.

    Impact of condition of young person (required)
    Please give details of the nature on their caring role, and the impact it has on their everyday life.

    Multiagency support (required)
    Please include any support your organisation has provided and any other organisations working with the young person.

    Risk Assessment (required)
    Are there any risks that we should be aware of regarding the young person or their family?

    Any other information

    Professional’s name (required)

    Professional’s role (required)

    Organisation (required)

    Professional’s phone number (required)

    Professional’s email address (required)

    Date of referral (required)