Referral

Young Carer Details
Address line 1
Address line 2
Town
Region
Country
Postcode
Does young person consent to the referral to Skye and Lochalsh Young Carers?  
 
If aged over 12 years does the young person consent to us contacting agencies and/or school mentioned in this referral for more information if appropriate?  
 
Parent/Guardian details
Address line 1
Address line 2
Town
Region
Country
Postcode
Does parent/guardian agree to Skye and Lochalsh Young Carers' Service contacting the agencies/school mentioned in this referral for more information as necessary and appropriate in order to process the referral?  
 
Does the parent/guardian agree to the Skye and Lochalsh Young Carers' Service notifying the school if the young person is a young carer so that they can receive some additional support when requested?  
 
Doctors' details
Is consent given by parent/guardian to provide medical support to young carer if required (e.g due to fall or injury during activity outings)? (required)  
School Details
Is school aware of this referral?  
 
Person in need of care
Does the cared for person live full time in the same home as the young person being referred ? (required) 
 
Is the young person the main carer providing care? (required) 
 
Further information
Address line 1
Address line 2
Town
Region
Country
Postcode
Privacy Statement: The Skye and Lochalsh Young Carer service is committed to abiding by the General Data Protection Regulations and respecting your rights to confidentiality and privacy. We collect family and school contact details so we can follow up and process this referral. We hold a record of any medical related information and we also collect clear consent for emergency medical treatment being sought and administered if considered necessary to help ensure YC’s safety and well-being. Some information may be anonymised (you will not be recognised) and used for statistical purposes as required by our Funders and the service to promote the Young Carer cause (i.e. age, gender, geographical area, diagnosis/illness and if young carer is the main carer). The more sensitive information we collect along with your clear consent to liaise with school will be used to assess the appropriateness and priority to be given to this referral and inform a potential support plan. Only senior staff, who need to know your information in order to fulfil their duties will have access to it and when it is no longer needed we will dispose of it securely (i.e.) within one month of an unsuccessful referral being assessed or within one year of young carer moving on from the service. You have the right to amend information or withdraw your consent by contacting the Young Carers’ Service Manager. (required) 
 
Captcha Test Image