Sandwell Carer Friendly ID Card Registration
Are you completing this on behalf of someone else?
Yes
Carer Details
First Name
Last Name
Date of Birth
Carer Situation
Please select...
Adult Carer (supporting an adult)
Parent Carer (supporting a child)
Parent Carer (supporting an adult)
Young Adult Carer (supporting an adult)
Young Adult Carer (supporting a sibling)
Young Carer (supporting an adult)
Young Carer (supporting a sibling)
If you are under 18, have you received permission from a Parent / Guardian to receive the card?
Yes
No
Email
Phone Number
Please check this is correct before submission
x
Your Address
We will send you Carers Card to this address
What is your Post Code?
Carer Organisation
What type of Card are you applying for
Please select...
New registration
The previous card has expired
Replacement for a lost / stolen card
When did you register as a carer with your local carers support service?
In Case of Emergency
On the reverse of each card, we will record your ‘In Case of Emergency’ (ICE) contact details. This is the person who will be called if anything happens to you, e.g. your partner’s name & number, a relative or friend’s name & number. If you do not have anyone who could be emergency contact, please give the name and contact number of your GP practice.
Full Name
Contact Number
Please make sure this is a number for your emergency contact
x
Card Setup
The picture needs to be a head and shoulders photo that you are comfortable using on the front of the card
Please Attach an Image here
The Peace of Mind Plan is a simple way to record key information about your caring role, in case you are unexpectedly unable to provide care due to illness or an emergency. It helps ensure the right people have the right information at the right time, reducing stress and uncertainty.
If you choose to include a Peace of Mind Plan, it will be securely linked to your Carer Friendly ID Card using a digital link. When scanned, this allows authorised services to quickly understand your caring situation without you needing to explain everything in a crisis.
Important
:
If you have requested to include a Peace of Mind Plan with your Carer Friendly ID Card, you will need to complete this form in full so we can finalise your card. Any delay in completing this form will delay your card being processed and issued.
Yes
No
If you are completing this on behalf of a carer, please complete the following:
Your Name
Your Organisation
Your Contact Number
Your Email
Please tick this box to say that you have read and understood the
privacy statement
Yes, I have read and understood the privacy statement
Contact Information