Carer Support Program Registration Form

Caring for Someone with Motor Neurone Disease (MND)

Caring for someone with MND can be both rewarding and deeply challenging, often leading to physical and emotional exhaustion. As the disease progresses, your loved one’s needs will change, and you may experience feelings of grief, sadness, or fear; these are all normal reactions.

Maintaining your own health and wellbeing is essential. It helps you cope better and continue providing the best care possible. Access to information, emotional support, and time to relax and recharge is critical.

Support from MND Queensland

At MND Queensland, we recognise the vital role unpaid carers play. Our MND Carer Support Program is designed to support you in your caring journey. Through this program, you can access:

✅ A safe space to connect and share with others in similar situations
✅ Resources and referrals to additional support services
✅ Opportunities to ask questions and seek information
✅ Invitations to carer-focused events
✅ Educational sessions from professionals on MND and caregiving
✅ Guidance on self-care and maintaining wellbeing
✅ Emotional support, including someone to talk to privately
✅ A chance to be yourself, and maybe even have some fun along the way

You Are Not Alone

Being a carer can feel isolating, but you are not alone. Connecting with others who understand your journey can make all the difference.

By completing our Registration Form, you'll be part of our Carer community; you won't be alone - MND Queensland will be here for you for as long as you need us.

Name*

First NameLast Name

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

SuburbState

Postcode

Email*

example@example.com

Contact Number*

Gender*

Do you require an Interpreter? (Languages and/or AUSLAN)*

YesNo

If yes, which language do you speak?*

Name of the Person you are/were caring for*

First NameLast Name

What is your relationship to the the person you are/were caring for?*

If other, please confirm your relationship*

As part of our Carer Support Program, we collect certain information to help us provide the best possible care and support. We’re committed to respecting your privacy and being transparent about how your information is used.

You’ll be asked to give consent, and you can choose what feels right for you. You’re also free to change your preferences at any time – just let us know.

For more details on how we protect your information, you can view our Privacy Policy HERE.

I provide my consent to MND Queensland to:

Create a confidential record about me on MND Queensland's Client Management System.*

Share information about me with other professionals and agencies to support referral and access to services. Please note, MND Queensland will seek your consent EVERY TIME we wish to share your information for this purpose.*

Utilise my de-identified data for the purposes of improving care and contributing to vital research.*

Take photographs and videos of me for the purposes of marketing and sharing on social media platforms to promote the Carer Support Program and the work MND Queensland does.*

MND Queensland is committed to developing activities that best support our carer's community. We'd appreciate your feedback on what would work best for you.

Are you interested in participating in online Carer Support Groups?

YesNoUnsure

Carer Support Program

About You

Your Connection to MND

Consent

Your Preferences