Kent Young Carers
To refer a young person aged 5-18  
to our service please complete this online referral
ALL PERSONAL DATA THAT YOU SUPPLY IS HELD IN STRICT ACCORDANCE WITH THE DATA PROTECTION ACT (1998)
Start
 
What is the young carers' First name? *

Please use a separate form for each child you are referring - we cannot accept multiple names on one form.
 
What is the young carers' family name? *

 
What Gender is the Young Carer *





 
Can we have {{answer_18501308}} date of birth

 
Please enter the Young Carers Home Address

 
Please give a full postcode

 
Please tell us about the young carers parent/guardian?

Please ensure they are aware of this referral
 
What is their full name *

 
What is the relationship to the young carer ? *


 
What is their phone number? *

Please include the area code.
 
Please give names, dates of birth, and relationship to young carer of all other members of the household.

 
What is the main language spoken at home?

 
What school does the young carer attend?

 
Who is the child caring for?


 
What type of conditions does the "cared for" have? *


 
Please tell us more about the cared for's condition?

this will help us to tailor the support we can offer the whole family
 
Does the young carer have any of the following? *


 
If the young carer has a help plan please upload it here

 
Please tell us why you are making this referral *

How would the young carer benefit from our support
 
Are there any other agencies working with the family?

     
 
You have indicated "yes there are other agencies working with the family", please give details below

 
Do any of the concerns listed below pertain to the Young Carer


 
Do any of the concerns listed below pertain to the Person being Cared for?


 
Are there any support needs for the young carer - ie allergies, health conditions, disabilities etc

 
Are there any safety issues within the home that we need to be aware of should the staff team be carrying out a home visit

e.g. dangerous dogs, risks for lone workers, remote location etc ?
 
Does anyone in the home show dangerous behaviour/known to be aggressive or violent?

     
 
Please give details

 
Almost there... please tell us a little bit about you, the person completing this form

 
Your Name *

 
Type of Referring Organisation *

If this is a family/self referral please dont forget to complete the consent form at the end of this questionnaire

 
“We offer free flexible training for professionals on how to identify, assess and support young carers.  If you are interested please contact the hub on Phone: 0300 111 111 0 or  Email: info@kentyoungcarers.org.uk

 
Please give your address

 
Telephone?

Just in case we need to check any details on this form
 
Has verbal consent been given for this referral? *

We need to know whether you have spoken to the parent/guardian about this referral so they are aware we will be in touch
     
 
Please ensure you have discussed this referral with the guardian/parent of the young carer

 
How did you hear about Kent Young Carers?

Thank you.
Your young carer's referral form has been submitted successfully.  If this is a parent/self referral please click the link below to enter consent details, if not just close this page.

One of our support workers will be in touch within 2 working days.  The Kent Young Carers hub can be reached on 0300 11 11 11 0 or by email info@kentyoungcarers.org.uk.
Parental Consent Form