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Carers Identity Passport Sign Up Form

Page 1

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Question 1.

Email Address
(Please add N/A if you do not have an email address)

- Required.
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Question 2.

First Name

- Required.
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Question 3.

Last Name

- Required.
Question 4.

What locality do you live in?

Question 5.

Your Address?
Question 6.

Are you looking after somebody?

A Carer is anyone, including children and adults who look after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid. (This includes whether you receive Carers Allowance or any other benefits) .

Question 7.

Please skip this question if you are over 18 years old.

If you are a Young Carer (a Carer under 18 years old) you can request a Carers Identity Passport specifically for Young Carers. This includes customised graphics on the back of the passport to help you discreetly ask for support from staff at school or college. To view the back of the Young Carers Identity Passport please Click Here.
Question 8.

Type of Carers Identity Passport

I would like....

Question 9.

How did you find out about the Carers Identity Passport?

By subscribing to the Carers Passport, Carers Voice Norfolk and Waveney will use the information you provide on this form to produce and send you a Carers Identity Passport. Carers Voice will also to be in touch with you to provide updates and information on the Carers Identity Passport. Carers Voice will use this information to check with you annually to ensure that details are still correct.  You can advise us at any time of any changes in information.  You can change your mind at any time by clicking the unsubscribe link in the footer of any Carers Identity Passport email you receive, or by contacting info@carersvoice.org.

We use Mailjet as our communications platform for the Carers Identity Passport and we will treat your information with respect. By clicking subscribe, you agree that we may process your information in accordance with these terms and your email address will be transferred to Mailjet for processing. Learn more about Mailjet’s privacy practices here.