residential-interest-form

🎒 Young Carer Residentials – Register Your Interest
If your child is a registered Young Carer aged 6–17, you can use this form to express interest in upcoming residential opportunities.

Our residentials offer young carers the chance to take a break, try new activities, and spend time with others in a supportive environment.

📋 How it works:

Complete the form below to tell us more about your child and their caring role
This helps us understand their needs and how a residential break may benefit them

🔔 Important:

Submitting this form does not guarantee a place on a residential
Spaces are offered based on individual need, suitability, and availability
Some residentials are designed for specific age groups, so not all opportunities will be suitable for everyone
We will contact you if a suitable residential becomes available

💬 Please complete the form as fully as possible so we can ensure each young person is offered the most appropriate opportunity.

Residential Expression of interest for Regsistered Young Carers

Full Name of Young Carer:

Are You a Registered Young Carer? (You must be regsistered with our service to submit this form)

Address of Young Carer:

Date of Birth

Contact Telephone number

Email Address

Who does the young person care for?

How does their caring role impact them?

In your own words, how would a residential break benefit the young person?

Does the young person have opportunities for holidays or breaks away from home?

Yes, Regularly

Sometimes

Rarely/Never

Has the Young Person stayed away from home before?

How do they feel about staying away from home?

Does the young person have any additional needs we should be aware of? (e.g. medical, dietary, behavioural, sensory)

Is there anything else you would like us to know when considering this young person for a residential?

Consent:

I understand this is an expression of interest and does not guarantee a place

I understand places are allocated based on need, suitability, and availability