Referral

Young Carer Details
Address line 1
Address line 2
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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
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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
Is the young person the main carer providing care? (required) 
 
Further information
Address line 1
Address line 2
Town
Region
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Postcode
I have read and understand that: The Skye and Lochalsh Young Carers' Service is committed to abiding by the Data Protection Act, as well as your rights to confidentiality and respect for privacy. We treat your private information with respect. It is kept secure and only those staff who are entitled to see it have access to it. We will do our best to keep information about you accurate and up to date and when we no longer have a need to keep information about you we will dispose of it in a secure manner. Some required information you have provided will be made anonymous and only used to provide the statistical information needed for reports to meet the requirements of the Young Carers' Service and its Funders. (required) 
 
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