Carers Card Application Form

Carers Card Application Form

Your Details

Title*

Forename(s)*

Surname*

Date of Birth

Address (line 1)*

Address (line 2)

Town

Postcode*

Contact Phone Number*

Email Address

What is the relationship of the person you care for to you?

What is the main health condition of the person being cared for?

The Carers Card enables you to set up a CRESS (Carers Respite Emergency Support Service) plan with East Sussex County Council. This includes contact details for up to three people who could provide short-term support for the person you care for in an emergency

Are you happy for us to contact you by phone about further support in your caring role, or adding a CRESS plan to your Carers Card?*

Yes, please contact meNo, discount card only

We provide information to help you with your caring journey via e-newsletter, magazine called Careline and occasional emails. If you do not wish to receive these communications, please follow the opt-out function available within the communication or contact us.

To see how we protect and use your personal data, you can read the Privacy Policy on our website.