Professional Referral | Barnet Young Carers

Barnet Young Carers is a service that supports children and young people between the ages of 5 — 17 and 18 – 25 who supports someone else (parent, sibling, other relative) on a daily basis who can't get by without their support and who might be affected by an illness, disability, mental health condition or substance misuse issue.

Regardless of the level of care provided, Barnet Young Carers supports children and young people who feel impacted by their caring responsibilities in their daily life (education, social life, physical and psychological wellbeing).

Please complete the questions below

Name of Professional*

Prefix First Last

Job Title of Professional*

Contact No. of Professional*

Email of Professional*

Organisational Sector*

Organisation of Professional*

How did you hear about us?*

If Other, please state*

Are you wishing to refer more than one Young Carer?*

Yes

If so, please indicate how many Young Carers you would like to refer*

Name of Young Carer #1*

First Last

Young Carer #1's Date of Birth*

Gender of Young Carer #1*

If Other, please state*

Preferred Pronouns Young Carer #1

Ethnicity of Young Carer #1

Parent/Guardian Name*

First Last

Parent/Guardian's Email*

Parent/Guardian's Mobile No:*

Parent/Guardian's Home Phone No:

Relationship to Young Carer #1*

If Other, please state*

Please enter your postcode below and click on the Lookup Postcode button

Address of Young Carer #1*

City*

Postcode*

School/College of Young Carer #1

Please enter the school/college Young Carer #1 attends*

Name of Young Carer #2*

First Last

Young Carer #2's Date of Birth*

Gender of Young Carer #2*

If Other, please state*

Preferred Pronouns Young Carer #2

Ethnicity of Young Carer #2*

Relationship to Young Carer #2*

Does Young Carer #2 live at the same address?*

Yes

Unsure

Please enter your postcode below and click on the Lookup Postcode button

Address of Young Carer #2*

City*

Postcode*

School/College of Young Carer #2*

Please enter the school/college Young Carer #2 attends*

Name of Young Carer #3*

First Last

Young Carer #3's Date of Birth*

Gender of Young Carer #3*

If Other, please state*

Preferred Pronouns Young Carer #3

Ethnicity of Young Carer #3*

Relationship to Young Carer #3*

Does Young Carer #3 live at the same address?*

Yes

Unsure

Please enter your postcode below and click on the Lookup Postcode button

Address of Young Carer #3*

City*

Postcode*

School/College of Young Carer #3*

Please enter the school/college Young Carer #3 attends*

Who the Young Carer cares for*

If Other, please state*

Name of Cared For Person*

First Last

Cared For Person's Condition*

Does the Young Carer(s) live with the Cared For Person?*

Yes

Unsure

Please enter your postcode below and click on the Lookup Postcode button

Cared For Person's Address*

City*

Postcode*

What areas does the Young Carer provide care:*

Domestic Tasks

Personal Care

Emotional Support

Practical Support

Other

If Other, please give details*

How does the caring role impact the Young Carer's daily life?*

Is there an intervention in place for the family?*

Yes

Unsure

If Yes, please select intervention in place*

Early Help Assessment (EHA)

Child In Need (CIN)

Child Protection (CP)

Please provide details of lead professional/allocated social worker (If preferable, CP/CIN/EHA Plans can be sent securely to [email protected] to avoid duplication.)

Are you aware of any risks within the home?*

Yes

Unsure

If Yes, please give details*

Services you would recommend for the young carer(s) you are referring*

Social activities and outings

1:1 Mentoring

Tuition

Training/workshops

Barnet Leisure Pass (for free swimming and discounted activities)

Integration into other local community activities

Other (please state)

Mental Fitness and Coaching Programme (16+)

Mentoring Referral

Please complete our Mentoring Referral Form

Tuition Referral

Please complete our Tuition Referral Form.

Please Note:
Submitting this form does not guarantee spaces for additional services which may have a waiting list and separated referral forms are required for some services.

Comments

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Professional Referral Form

Professional Referral Form

Please complete the questions below

Mentoring Referral

Tuition Referral