Young Carers Referral

Online form

To refer a Young Carer, you can use the online form below.

Word form

Alternatively, you can download the form in Microsoft Word format.

To submit the Word version, email it to Young.Carers@thecarerscentre.org. 

Additional Documents and help

With either form, you’ll also need the Fair Processing Notice PDF. We also have Referral Guidance available.

If you would like to discuss a referral or have any questions about the form, you can call the Young Carers Team Manager on (01273) 746 222 for more information.


    The young person

    Child's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    Please ask the young person the following: (Please complete this with the young person, it is important it reflects their experiences.) You must answer the 8 multiple choice questions. The follow-up questions are optional but very helpful if relevant.

    1 Do you carry out personal care, manual handling or administer medication?


    1b If relevant, please detail which personal care or medication-related tasks you carry out:
    2 Do you get worried/angry/stressed as a result of your caring role?


    2b Please detail anything in particular that worries you in relation to your caring role:
    3 Is your school life impacted by your caring role?


    3b Please detail how school life is impacted by caring role e.g. lateness/absence/bullying/feeling isolated:
    4 Is your social life impacted by your caring role?


    4b Please detail how social life is impacted by caring role e.g. having to come straight home from school:
    5 Do you know what to do and who to contact in an emergency? (Answer 1-5, 5 being very confident).


    5b If relevant, please give an example of an emergency relating to the caring role which you have faced:
    6 Do you feel well supported by the professionals in your life?


    6b Please list existing support networks you access e.g. school counsellor/youth club:
    7 Do you feel able to make independent choices in your life?


    7b Please detail things you feel in control of e.g. courses at school, choosing games to play at home:
    8 Do you feel appreciated and proud when helping the person you care for?


    8b Please detail how your parents/adults show that they are grateful for the support provided:
    Add another young person

    Young person 2

    Child's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    1 Do you carry out personal care, manual handling or administer medication? 1b If relevant, please detail which personal care or medication-related tasks you carry out: 2 Do you get worried/angry/stressed as a result of your caring role? 2b Please detail anything in particular that worries you in relation to your caring role: 3 Is your school life impacted by your caring role? 3b Please detail how school life is impacted by caring role e.g. lateness/absence/bullying/feeling isolated: 4 Is your social life impacted by your caring role? 4b Please detail how social life is impacted by caring role e.g. having to come straight home from school: 5 Do you know what to do and who to contact in an emergency? (Answer 1-5, 5 being very confident). 5b If relevant, please give an example of an emergency relating to the caring role which you have faced: 6 Do you feel well supported by the professionals in your life? 6b Please list existing support networks you access e.g. school counsellor/youth club: 7 Do you feel able to make independent choices in your life? 7b Please detail things you feel in control of e.g. courses at school, choosing games to play at home: 8 Do you feel appreciated and proud when helping the person you care for? 8b Please detail how your parents/adults show that they are grateful for the support provided:
    Add another young person

    Young person 3

    Child's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    1 Do you carry out personal care, manual handling or administer medication? 1b If relevant, please detail which personal care or medication-related tasks you carry out: 2 Do you get worried/angry/stressed as a result of your caring role? 2b Please detail anything in particular that worries you in relation to your caring role: 3 Is your school life impacted by your caring role? 3b Please detail how school life is impacted by caring role e.g. lateness/absence/bullying/feeling isolated: 4 Is your social life impacted by your caring role? 4b Please detail how social life is impacted by caring role e.g. having to come straight home from school: 5 Do you know what to do and who to contact in an emergency? (Answer 1-5, 5 being very confident). 5b If relevant, please give an example of an emergency relating to the caring role which you have faced: 6 Do you feel well supported by the professionals in your life? 6b Please list existing support networks you access e.g. school counsellor/youth club: 7 Do you feel able to make independent choices in your life? 7b Please detail things you feel in control of e.g. courses at school, choosing games to play at home: 8 Do you feel appreciated and proud when helping the person you care for? 8b Please detail how your parents/adults show that they are grateful for the support provided:

    The professional

    Family have been shown the Fair Processing Notice (opens in new window) & consent to The Carers’ Centre and Local Authority storing their details? YesNo

    The responsible adult

    Adult's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    Add another responsible adult

    Responsible adult 2

    Adult's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    The cared for person

    Cared-for person's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    Lives at family address? YesNo
    Add another cared for person

    Cared for person 2

    Cared-for person's Gender (required)

    Please specify:

    Is their gender identity the same as the gender they were assigned at birth?
    YesNoPrefer not to sayUnknown

    Lives at family address? YesNo

    Existing support

    Lives at family address? YesNo

    About the referral

    Risk factors

    YesNo
    If NO, why not?

    Support Plan? CiNTAFCP

    If CP, Date of Registration:
    If CP, Category: EmotionalPhysicalSexualNeglect

    Many thanks for your referral.

    Please note the following about our procedures:

    • We aim to processing all referrals within 6-8 weeks. Please be patient as we are a small organisation.
    • Where there is not a social worker involved with the family, our referrals are screened by a Brighton & Hove City Council Young Carers Family Coach to ensure that the whole family is being supported appropriately
    • If you have any additional questions about our procedures, please contact our team on 01273 746 222.