Forth Valley Carers Card application form

Forth Valley Carers Card application form

To receive a Forth Valley Carers Card, you must reside in Falkirk or Clackmannanshire, and be registered with the Carers Centre. If you live in another district, please email us at centre@centralcarers.co.uk or call us on 01324 611 510 (option 1).

If you are not registered, we will send you an email once you submit your application, which will include a link for you to register with Falkirk & Clackmannanshire Carers Centre.

If you have any questions about this form, or if you need support to complete the form, please contact us using the details above.

I live in...*

Are you already registered with Falkirk & Clackmannanshire Carers Centre?*

YesNoDon't know

Reference number*

Please enter the 3-5 digit reference number found on your letter or email

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Post Code

Phone Number*

Email

example@example.com

Would you like a physical card, or a digital PDF to use on your phone?*

Physical cardDigital card

Carers Card picture upload*

Please provide a passport-style picture of yourself, prefably taken against a plain background.

Would you like to speak with a carer support worker to discuss your caring role?*

YesNo

If you would like to provide any feedback on this trial process so far, you can do so here:

All information provided on this form will be treated as strictly confidential, kept securely and not shared without your consent or knowledge, except under exceptional circumstances. Full information about the information we collect and how it is treated is contained in our Privacy Notice which is from the Carers Centre and on our website.

Please see these links for further information about JotForm's privacy policy (https://www.jotform.com/privacy/) and how your information is stored (https://www.jotform.com/eu-safe-forms/).

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