Date of Birth
MaleFemaleNon-binaryOther (please specify)
WhiteMixed or Multiple Ethnic GroupsAsian, Asian Scottish or Asian BritishAfrican, Caribbean or BlackOther Ethnic BackgroundOther (please specify)
Does the Young Carer have any health issues or additional support needs?
Does the Young Carer have their own Social Worker? If so, who?
Is the Young Carer currently on the Child Protection Register?
Has a Young Carers Statement been completed?
Guidance/ Pastarol Teacher
Is the School aware that the young person has a caring role?
Has the Young Carer, together with their Parent/Guardian, given consent to provide their details and refer them to our organisation?