Young Carers Registration Form
A Young Carer is someone aged 17 or under, who helps look after a relative who has a condition such as a disability, illness, mental health condition, or a drug or alcohol problem.

Being a Young Carer isn't always easy - but you are not alone.

At Southend Carers, we offer friendly advice, raise awareness, identify and provide direct support to children and young people who look after or help to look after someone in their family.

Southend Carers' Better Lives programme is funded by People's Health Trust and offers specific support for Young Carers aged 5-17 years. We offer a regular monthly fun event, weekly after school clubs, and access to useful information and local services, making sure you can get the support you need.

Our support to Young Carers is completely FREE and confidential.

Southend Carers is a registered charity and our mission is to make life easier and fairer to Carers in Southend-on-Sea.

To join us, all you (or an adult) have to do is fill in this form and get your parent, guardian or someone supporting you to send it back to "FREEPOST Southend Carers" - No stamp needed.

Email address *
Confirm Email Address (IMPORTANT - we communicate via email whenever possible)
Your answer
Young Carers Name *
Your answer
Date of Birth *
Your answer
Age *
Your answer
Gender *
Parent(s) Name(s) *
Your answer
Address *
Your answer
Postcode *
Your answer
Mobile Telephone Number (preferred)
Your answer
Landline Number (if you have one)
Your answer
Child's School / College *
Your answer
Does your teacher / tutor know that you are a Young Carer? *
If no, could you tell us why?
Your answer
Does your school / college offer any special support for Young Carers? *
If yes, what kind of support is offered?
Your answer
Do you access this support? *
If no, could you tell us why?
Your answer
Do you have access to the following at home?
Ethnic Group or Background
Please choose one option which best describes your ethnic group or background
Mixed / Multiple Ethnic Groups
Asian / Asian British
Black / African / Caribbean / Black British
Other Ethnic Group
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