Thurrock Young Carers Referral Form

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** There is currently a waiting list and we will be in contact as soon as possible with the Young Carer and their family. In the meantime please look at our Thurrock Young Carers website to find out more about the project www.youngcarerscentre.org.uk **

Client Authorisation - (PLEASE READ TO THE PARENT / CARER OF THE YOUNG PERSON/S YOU ARE REFERRING) - Please note that the below information will be entered onto our database but will not be used for marketing purposes or passed through to any unauthorised persons / organisations.

**Please provide as much information and the reason for the referral so that we have as much information as possible before contacting the family**

Email *

Date of referral:

YYYY

How many Young Carers are you referring? (Please note that if you are referring more than three you will need to completed an additional form. Support is for ages 8 - 18 years old.) *

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