Carers Count – Count me in!
Do you look after a relative or friend?
If you provide support to someone who is ill, elderly or has a disability, and that person cannot manage without your help, then you’re a CARER. Carers can be parents, young people, friends or neighbours. There are no restrictions on who is a Carer: if you care for someone - you’re a Carer. The last Census shows there are about 38,000 Carers in Herefordshire - only about 4,200 of them are registered. We want all Carers to register with Herefordshire Carers Support (HCS is a registered charity working for Carers).
The more Carers that are registered, the stronger our voice will be to ensure that Carers:
üAre Recognised üAre Valued üGet Better Services
Registering with HCS is free and will give you access to our services. To find out more about our work, visit our web site www.herefordshirecarerssupport.org or phone our office on 01432 356068
Please fill in the short registration form below, and help us to work for the benefit of all Carers in Herefordshire. You can also register by faxing through to 01432 356149.
……………………………………………………………………………….…………………….………………………
Please register me as a Carer. Tick box to register ¨
First Name: …………………………………………..…. Surname: ……………..………….……………......
Mrs/Mr/Miss/other (Please state) …………………….. Date of Birth: …………………………………………………
Address: ……………………………………………………………….……………………………......
……………………………………………………………………………. Postcode: ………………………………………………………..
Phone Number: ………………………………………………….. E-mail: …………………..……..…………………………………
Your GP Practice name: …………………………………………………..…………………………………………………………………
Ethnicity: …………………………………….. Approximate hours per week spent caring: …………………………..
Name of the person you care for: ………………………………………………………….…………………………………………..
Their date of birth: ………………………………………. Their relationship to you: ……………………….……….
Brief description of their health condition: ………………………………………………………………......
Return to:
Freepost RTGA-ELYH-SXHA, Herefordshire Carers Support, Bath Street, HEREFORD, HR1 2HE
You do not have to provide personal information to us, but it helps us in planning services. If you agree to your personal data being held and processed by Herefordshire Carers Support please tick the box. ¨
We will remove your details from our database at any time if you request it to be done.
Contact our data controller Nick Jones for any queries regarding data collection and handling.
Charity No. 1051774 Company No. 03032478. Our ref: HCS WEBSITE 2014
HCS © Reviewed Jan 2014