Young Carer Wellbeing Referral Form

Young Carer Wellbeing Referral Form
Information for Parents/Guardians

Once we receive a referral, a practitioner will reach out to gather more information, assess whether wellbeing support is suitable for your child, and provide guidance on the next steps. For further details, please refer to our Parental Guide: https://carersinbeds.org.uk/wp-content/uploads/2024/09/Parental-Guide-For-Young-Carers-Receiving-Wellbeing-Support.pdf
Information for Schools/Colleges

As part of our support for young carers, we seek your assistance in facilitating wellbeing sessions during school hours. We kindly request your support in providing a confidential space for these sessions and ensuring that young carers attend promptly. Please note that if young people do not arrive on time, sessions may need to be cancelled or rescheduled.
Is the young person registered with Carers in Bedfordshire?*

YesNo
Note:

Before accessing Wellbeing Support, the young person must be registered with our service. Please review the Referral Criteria. If the young person is not registered with Carers in Bedfordshire, please ensure they are registered before referring for Wellbeing support. To register please copy and paste this link: https://carersinbeds.org.uk/register/. If the young person is already registered, please provide updates to any contact or information in the relevant fields below.
Referrer Information
Full name:*
Relationship to young carer: *
Email address*
Contact number *
Is the young person aware of the referral for Wellbeing Support*

YesNo
Note:

It is encouraged that the opportunity for Wellbeing Support is discussed with the young person before making the referral.
Has the parent/guardian consented to the referral?*

YesNo
Note:

If you are the Parent/Guardian, please select YES if you consent to your child accessing Wellbeing support.
Has the young person’s school/college been notified of this referral?*

YesNo
Note:

As most Wellbeing sessions take place at school, it is recommended that their education provider is informed.

Young Carer Information
Full name:*
Date of birth*
Home address*
School/College*
Email address*
Contact number*
Reason for Wellbeing Support referral - Please provide as much information as possible in regard to the young person's caring role. Limited information may cause a delay with your referral and access to wellbeing support. Please refer to the Young Carer Wellbeing Support FAQs and Eligibility document to support with this question if needed.
Parent/Guardian Information
Full name*
Address*
Email address*
Contact number*

Wellbeing Support - Terms and Conditions
Consent

Participation in the sessions requires parental or guardian consent for the young person. By signing up for Wellbeing Support, parents/guardians agree that their child can access the wellbeing services offered
Confidentiality

All discussions between the student and wellbeing staff will remain confidential, except in cases where there are concerns for the safety and wellbeing of the young person.
Data Protection

All personal information is stored in accordance with Carers in Bedfordshire's company policy and the Data Protection Act 2018.
Attendance and Commitment

Attending all Wellbeing sessions is strongly encouraged to ensure the young person gains the full benefit of the support available. Consistent non-attendance may lead to a review of the young person’s wellbeing support plan. Please be aware that if a young person is more than 10 minutes late to a session, the session may be cancelled.
Thank you very much for taking the time to complete the Referral Form. Please note that upon completing this referral, it can take up to two weeks to receive a response. If you have not received a response within 2 weeks of your referral, please contact Carers in Bedfordshire and ask to speak to the Young Carers Wellbeing Practitioner.
Young Carers Team Contact Information

Telephone number: 0300 111 1919 Young Carers Team email address: young.team@carersinbeds.org.uk Young Carers Wellbeing Practitioner email address: justine.moodley@carersinbeds.org.uk
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Young Carer Wellbeing Referral Form

Information for Parents/Guardians

Information for Schools/Colleges

Note:

Referrer Information

Note:

Note:

Note:

Young Carer Information

Parent/Guardian Information

Wellbeing Support - Terms and Conditions

Consent

Confidentiality

Data Protection

Attendance and Commitment

Young Carers Team Contact Information