Walsall Carer Friendly ID Card Registration

The Carer Friendly ID Card allows Carers to self-identify as a Carer. This can be to professionals such as GPs when supporting the person they care for or to get offers at specific organisations/ locations. It can also be used to help in an emergency reach nominated persons who can take care of

As part of the Carer ID Card, you will need to provide some additional information.
This includes:

Information about who you are caring for,
Two people you can name as emergency contacts
A photo of yourself to use to identify your card.

Please have all of this information to hand before completing this form

Carer Details

First Name

Last Name

Date of Birth

Carer Situation

If you are under 18, have you received permission from a Parent / Guardian to receive the card?

YesNo

Phone Number

Please check this is correct before submission

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

When did you register as a carer with your local carers support service?

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

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 of your emergency contact

Contact Number of your emergency contact

Please make sure this is a number for your emergency contact

Relationship to you

Has this person given consent for their details to be held on our database?

Yes they have given consent

Do you have a second person who can be contacted in an emergency?

YesNo

Second Emergency Contact

Full Name of your second emergency contact

Contact Number of your second emergency contact

Please make sure this is a number for your emergency contact

Relationship to you

Has this person given consent for their details to be held on our database?

Yes they have given consent

Immediate considerations for the person you cared for

Name of Person requiring support

Relationship to you

Cared Fors address

Please let us know of any immediate considerations regarding the person you care for

If Other, please provide details

Does the person you care for give consent for their information to be recorded?

Peace of Mind Plan

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.

YesNo