Birmingham 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
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
Receiving Your Card
You will need to pick up your Carers Card in person. We have a number of Drop in locations available across Birmingham that you can select. Please more details of when these Drop ins take place on our
website
Which of the following locations would suit you best?
Please select...
Hawkesley Community Centre - 51 Edgewood Road, Kings Norton
TouchBase Pears - 750 Bristol Road, Selly Oak
Moorfield Hall - 80 – 84 Hartshill Road, Shard End
Age Concern Birmingham Communitea Café - 76-78 Boldmere Road, Sutton Coldfield
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