Register with Support For Carers

Registration only takes a few minutes and it means we'll be able to give you tailored, one-to-one support and advice to suit your needs.

Please note you need to have an email address to register with us. If you don't have an email address or you'd prefer to talk to us by phone please call 01858 468543.

About you

Let's get started

* Email Address:

Ensure that you check your email address is correct otherwise we will be unable to verify your account information. Also, please be aware that passwords are case sensitive, and must be a minimum of 6 characters which can be any combination of alphas and numerics.

* Password: * Confirm Password * Your Title: Mr/Mrs/Miss/Ms * Your First Name/s: * Your Second Name/s: Are you: Male/Female

Male Female

* Your Date of Birth: Ethnic Origin: * Your Home Address: * What is the best phone number to contact you on? * Do you have an alternative number e.g. a Mobile? * How would you prefer to be contacted:

By phone By e-mail By post

* How would you prefer to receive information from Support for Carers including our newsletter?:

By email By post I do not want to receive information

* Opt-out of receiving information including the newsletter at any time by emailing [email protected] or calling 01858 468 543

How long have you been a carer? Are you: Which district do you pay your Council Tax to?: Other:

About the person you care for

Remember, the more you tell us, the more we'll be able to help you and we won't share this information with anyone else without your permission.

Their Title Their First Name/s: Their Second Name/s: Are they male/female?

Female Male

* Their date of Birth: Their address (if different to yours): Their relationship to you? Their condition

Asperger Syndrome
Dual sensory Disabilities
Learning Disabilities
Mental Health / Dementia
Mental Health
Not Known
Older Person
Physical Disabilities
Sensory Disabilities
Substance Misuse
Cancer
Neurological Condition
Other (please state)

Other (please provide details)
Does the person you care for receive Direct Payments?

Yes No Don't know

Do you think the person you care for would be able to cope without you?

What support would you like from us?

This section is your chance to tell us what kind of help you need

Do you need help with your own health and wellbeing?

YES NO

Please tell us anything that you think would help us including details of the support you'd like.
For example, would you like to talk to someone in confidence about your feelings or the issues you face as a carer? Do you have any health problems yourself? Would you like help with staying healthy including advice on eating well and exercising?

Keeping your information private and confidential

Nearly there now!

Are you happy for us to share the information you've provided, if relevant, with the other organisations you've mentioned?
For example, a GP or Social Services

YES NO

How did you find out about the Support for Carers service? Other (please provide details)

Support for Carers Terms and Conditions and Privacy Policy

I have read and agree to the Support for Carers terms and conditions and privacy statement.
Accept Terms and Privacy Policy. *

Support for Carers Leicestershire is funded by Leicestershire County Council. However, we rely on donations to enhance the services we provide for carers in the area. If you would like to support us please contact us.

Register with Support For Carers

Keeping your information private and confidential

Support for Carers Terms and Conditions and Privacy Policy

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Support for Carers Leicestershire is funded by Leicestershire County Council. However, we rely on donations to enhance the services we provide for carers in the area. If you would like to support us please contact us.