Young Carers Registration Form
Shetland Care Attendant Scheme (SCAS) Carer Advice & Information Service
Before you complete this form
By providing your details, you are giving us permission to make contact with your parent/guardian about your caring role. We may also follow up your referral by telephone with your parent/guardian, the professional who helped you complete the form, or through a school visit, depending on what is most appropriate. You may not have all the information we ask for, so please don't worry if you are unable to answer every question.
Who is making the registration?
*
I am the young carer and would like to register myself
I am the Parent/Guardian and would like to register my child as a Young Carer (with their consent)
I am a Professional assisting the Young Carer/ Parent/ Guardian to complete this referral
Name of professional who helped you complete this form:
Organisation
Professional's telephone number:
1. Young Carers Full Name
*
2. Young Carers Date of Birth
*
3. Gender
4. Address, including postcode
*
5. Young Carers Phone Number
6. Young Carer’s email address (if aged 13 or over and they would like to receive our e-newsletter):
7. Ethnicity
Please Select
White English/Welsh/Scottish/Northern Irish/British
White Irish
White Gypsy or Irish Traveller
Any other White background
White and Black Caribbean
White and Black African
White and Asian
Asian/Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Black/African/Caribbean/Black British
African
Caribbean
Any other Black/African/Caribbean background
Arab
Other ethnic group
8. Is the Young Carer from an Armed Forces family or veteran family?
*
Yes
No
Unknown
9. Full name of Parent/Guardian with Parental Responsibility
*
10. Relationship to Young Carer
*
11. Parent/ Guardian phone number (please include mobile and home if applicable)
*
12. Parent/ Guardian email address
13. Is the Young Carer at school or college?
*
Yes
No
14. Name of School/College
*
15. Is the school aware of the caring role?
*
Yes
No
Unknown
N/A
16. Name of person the Young Carer carers for
*
17. What is their relationship to the Young Carer? (For example: If the young person is caring for their Mum, Dad, Brother, Sister, Grandparent).
*
18. What is the condition or support need of the person/people the Young Carer cares for? Please select all that apply.
*
Physical disability
Mental health
Stroke
Substance misuse
Learning disability
Dementia or age-related condition
Sensory impairment
Long-term illness
Other
19. How does the Young Carer help the person they care for? Please select all that apply.
*
Helping with medication
Helping with personal care
Helping with shopping, cleaning, washing or other household chores
Listening to them or providing emotional support
Playing with them or supervising them
Staying at home with them
Other
20. How long has the Young Carer been providing care for the person?
*
Under 1 year
1 - 3 years
3 - 6 years
6 - 9 years
9 years +
21. How many hours a week does the young carer spend caring?
*
Under 4 hours
5 -15 hours
16 - 24 hours
25 - 34 hours
35+ hours
22. Is there any support already in place or other services involved - please tell us below:
*
23. Does the Young Carer have any diagnosed illnesses/disabilities? (Please tell us as much as possible about this)
*
24. Does the young person have a Young Carer Statement?
*
Yes
No
Not sure
25. Anything else you wish to tell us or we should know about the Young Person's caring role?
26. How did you find out about the Shetland Care Attendant Scheme (SCAS) Carer Advice and Information Service? (Please select one)
*
Friend or family member
Teacher or other school staff
Health or social care professional
Another organisation or service
Leaflet or poster
SCAS website
Social media
Event or community group
Someone from SCAS
I can't remember
Other
Submit
Should be Empty: