Make a Referral

Reason

  • Carer
  • Cared for
  • Reason
  • Consent
  • Send

Adult Carer

Name

First line of address

Second line of address

Town

County

Postcode

Email

Telephone

Date of birth

Gender

Relationship to cared for person

Ethnicity

Carer GP

Carer health

Has a formal Carers Assessment been carried out by local authority?

Other information (additional caring/childcare responsibilities, current circumstances)

Where did you hear about Carers Lewisham?

Cared for

Cared for name

Cared for address (if different from carer)

Cared for Date of Birth

Cared for Gender

Cared for Ethnicity

Cared for GP

Disability/Health problem

Has a Care Needs Assessment been carried out by the local authority?

How does the disability/illness affect them?

Reason

Reason for referal

Carer Consent

I agree that Carers Lewisham’s staff and volunteers can process my personal details to enable appropriate support to be identified for me and the person I care for.

I give my permission for my personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw my consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

I confirm that I am happy to be contacted by

Cared for person’s consent

I agree that Carers Lewisham’s staff and volunteers can process my personal details to enable appropriate support to be identified for me and my carer.

I give my permission for my personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw my consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

Consent on behalf of the cared for person

TO THE CARER: Please fill out the below section only if the Cared for Person is: Under 18 and you are the parent, guardian or tutor; lacking in mental capacity and you have legal rights to sign on their behalf

I agree that Carers Lewisham’s staff and volunteers can process the cared for person’s personal details to enable appropriate support to be identified for them and myself.

I give my permission for the cared for person’s personal details to be shared with other partners involved in the delivery of the service in accordance with the new General Data Protection Regulation (GDPR)

I understand I can withdraw the cared for person’s consent at any time by contacting info@carerslewisham.org.uk or 020 8699 8686

GPDR

We will never share your personal data with any outside agency or company without your permission unless required to do so by law. You are entitled to view your record at any time by giving us 48 hours notice in writing.

In order to receive support from the Carers Lewisham Young Carers Programme, every child must first be referred to our service. If you would like to refer a child between the ages of 5-15, please click on the link below to download the 4-page referral form. (You have the option of downloading a Word or PDF version of our referral form).

PLEASE NOTE: We no longer accept self-referrals from families for children 15 and under.

We now require all 5-15 referrals to come through:

  • a professional working with the family (such as a social worker)
  • someone at the child’s school who is aware of their caring role (teacher or pastoral lead)
  • the family or child’s GP who is aware of their caring role.

This helps ensure that any Young Carer being referred to us is also recognised by another source of support in that child’s life.

Once you have downloaded the referral form, please complete all the sections and obtain the parent/guardian’s permissions and signature on the Consents page. Please also make sure that the child being referred completes the Young Carer Questionnaire on the last page of the referral form. If more than one child is being referred from the same family, please make extra copies of the Young Carer Questionnaire so that each child completes their own questionnaire.

Email the completed form to: info@carerslewisham.org.uk

Or send the form by post to:

Carers Lewisham Young Carers Programme
Waldram Place
Forest Hill
London SE23 2LB

After we receive your form, we will review it and respond to you within one week indicating whether the child meets the criteria for acceptance into the Young Carers Programme. If accepted, we will send out a Welcome Letter to the family informing them about upcoming events for Young Carers.

Download Young Carer (5-15) referral form:   Word   PDF

The Children and Families Act 2014 and Care Act 2014 gives Young Carers rights to be assessed by local authorities in order to address their need for support as well as to safeguard against inappropriate care. If you are worried about a child or are concerned about an ongoing issue involving a child, please contact the Multi-Agency Safeguarding Hub (MASH) directly on 020 8314 6660 (out of hours call 020 8314 6000) or email them on mashagency@lewisham.gov.uk.

For urgent child protection referrals, contact the MASH on 020 8314 9181. If you think a child or young person may be in immediate danger, call 999 or contact your local police on 101. 

In order to receive support from the Carers Lewisham Young Adult Carers Programme, every young person must first be referred to our service. If you would like to refer a young person between the ages of 16-25, please click on the link below to download the 4-page referral form. (You have the option of downloading a Word or PDF version of our referral form).

PLEASE NOTE: If you are 16+, you can also refer yourself if you think you are Young Adult Carer. You do not need your parent’s/guardian’s consent or permission to refer yourself to our service and your referral will kept confidential.

Once accepted into our service, you also have the option to communicate with our service only through your own mobile phone in order to keep your participation confidential.

Once you have downloaded the referral form, please complete all the sections and make sure the young person signs the Consents page. Please also make sure that the young person being referred completes the Young Adult Carer Questionnaire on the last page of the referral form.

Email the completed form to: info@carerslewisham.org.uk

Or send the form by post to:

Carers Lewisham Young Adult Carers Programme
Waldram Place
Forest Hill
London SE23 2LB

Once we have received your form, we will review it and respond to you within one week indicating whether the young person meets the criteria for acceptance into the Young Adult Carers Programme. We will then send out more information about our Program to the young person directly by email or the family by post.

Download Young Adult Carer (16-25) referral form:   Word   PDF

The Children and Families Act 2014 and Care Act 2014 gives Young Carers rights to be assessed by local authorities in order to address their need for support as well as to safeguard against inappropriate care. If you are worried about a child or are concerned about an ongoing issue involving a child, please contact the Multi-Agency Safeguarding Hub (MASH) directly on 020-8314 6660 (out of hours call 020-8314 6000) or email them on ashagency@lewisham.gov.uk.

For urgent child protection referrals, contact the MASH on 020-8314 9181. If you think a child or young person may be in immediate danger, call 999 or contact your local police on 101.

Carers Lewisham
Waldram Place
Forest Hill
London
SE23 2LB

Opening Times:
Monday to Friday 9am-5pm

 

Carers Lewisham is a Carers Trust Network Partner and is accredited by Advice Quality Standard Mark.

We are funded by London Borough of Lewisham, NHS Lewisham (CCG), Children in Need, Donations and Legacies.

Registered Charity No: 1073592
Company Registered in England No: 3681548

All content Carers Lewisham ©2019