Information about you (the carer)

By submitting this form, I confirm that I am an unpaid carer in East Sussex and I wish to register with Care for the Carers and receive access details for the digital resource for carers. I give my consent for Care for the Carers to hold my personal data on their secure database in line with their privacy policy (www.cftc.org.uk/privacy-policy/). I give consent for Care for the Carers to send me details of how to access the digital resource for carers and to email me the e-newsletter and CareLine by email if I have selected those options below.

If you are completing this form on behalf of someone else, please ensure that they give their consent as above. If you are unable to complete this form, please call Care for the Carers on 01323 738390.

Title*

Surname*

Forename(s)*

Address line 1*

Address line 2

Address line 3

Address line 4 (Town)*

Address line 5 (County)*

Postcode*

Main Telephone No.*

Email Address (Main)*

Date of Birth*

Gender*

Ethnic Group*

Sexual Orientation*

Marital Status*

Religious Group*

GP Surgery*

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

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

Carer’s main health issue or disability, if any (if none, select no disability or health issue)*

Would you like to receive our monthly e-newsletter?*

Would you like to receive our quarterly CareLine magazine by email?*

Please comment in the box below if you would like support from Care for the Carers in relation to your caring role, in addition to receiving the digital resource information. We will endeavour to contact you as soon as possible. If you need support urgently, please contact us on 01323 738390 or info@cftc.org.uk

Referral Project

Thank you for registering with Care for the Carers. After you click ‘submit’, we will email you within 5 working days with details of how to access the digital resource for carers. Please monitor your junk folder in case our email gets diverted there.