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Call us: 01670 320025

info@carersnorthumberland.org.uk

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Our Services
Carers
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Get In Touch
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Registration

Home
Registration

Your Details

Title

Surname

First name

Your Address

Address 1

Address 2

Town

County

Post Code

Contact Telephone Number

Mobile Number

Email Address

Are you a?

Further Details

How many hours a week do you spend caring?

Gender

Male
Female
Unspecified

Date of Birth

Equality Monitoring

All information will be held anonymously, and will only be used to inform funders and other stakeholders of the reach of our services.

Ethnic Origin

Religion or Belief

Economic Status

GP Surgery

Does your GP know you are a carer

Yes
No

Sexual Orientation

Carer Group Please select which applies to you...

How did you find out about Carers Northumberland?

What made you register with us today?

Is there anything you would like help with right now or do you have a question? Please leave comments in the below box and a member of the team will contact you.

About the person you care for...

Gender

Surname

Date of Birth

Main disability

Post code The first section only i.e. NE63

Are you

Primary carer
Secondary carer

What is their relationship to you?

Consents

I understand by completing this form I consent to the details I To be registered with Carers Northumberland we need to hold information about you on our secure database, this information is not shared without your consent to any other outside organisation or person ( except where we are legally required to do so, for example in safeguarding situations) Your information will be stored for up to six years after your contact with Carers Northumberland has ended, after which time it will be securely destroyed. * If you would like to know more about how we store and use your data you can request a copy of our privacy statement by emailing: info@carersnorthumberland.org.uk or calling 01670 320025. Please note by selecting no, we cannot continue with your application.

Yes
No

I consent to Carers Northumberland contacting me by phone and text *

Yes
No

I understand that my email address will be used as the main way of keeping me updated and sending out the monthly e-newsletter. I consent to my email being used in this way *

Yes
No

I understand that I can remove permissions for contact at any time by contacting Carers Northumberland directly. *

Yes
No

Which Carers Northumberland services do you think you will use?

Newsletter - Our Bi-Monthly newsletter can be provided by post or email to keep you in the loop

Carers Emergency Card - Carry this card and if something happens to you, help will be arranged for the person you look after. A great “peace of mind” service.

Carer Support Fund - Small grants for carers to enable them to take a break.

Carer Groups - Meet other carers, have a cuppa and a chat, make friends and get information.

Workshops and Training - Regular programme of workshops and training on a range of topics like guilt, contingency planning and how to say no.

Telephone support - Talk to our friendly staff about what matters to you, chat in confidence and get things off your chest.

Information and Advice - Our knowledgeable advisors can help with welfare rights, carers rights, social care issues, housing, respite and more. They can also refer and signpost to a range of other services in Northumberland.

In this section please tell us how you feel about each subject, circle the description that best fits how you feel right now. How do you feel about:

Employment, Education and Training

Accessing Support

Finance, Money and Benefits

Taking a Break and Time for Myself