new
                                                    
               
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 (* denotes mandatory fields)
Data sharing consent
In order to support you we need to know some personal information about you and the person you care for, including how we can contact you about services. We need this information to ensure our services and those that other agencies offer you, meet your needs.

We may share information with organisations who fund us, including the local authority and the NHS.  Further details of how we handle your personal information can be found on our website.(Carers in Bedfordshire Privacy Policy).


Registration details

Hidden fields
Person affected by Memory Loss or Dementia 
Test Records
Test Mode

Form is in Test mode - New Referral notifications are sent to the Test Support Worker user

Address
Marketing Communications
Occasionally we may wish to contact you with information on the charity’s broader activities and services. This may include Carers Discount Card offers, job and volunteering opportunities, fundraising activities.

Are you happy to receive information that we believe will interest you on topics like these?
Preferred contact method(s)
Person affected by Memory Loss or Dementia Monitoring
PMD Other information
Not Used - PMD Other information
PMD Notes
Carer of the person affected by memory loss or dementia
Marketing Communications
Occasionally we may wish to contact you with information on the charity’s broader activities and services. This may include Carers Discount Card offers, job and volunteering opportunities, fundraising activities.

Are you happy to receive information that we believe will interest you on topics like these?
Preferred contact method(s)
Carer Gender and DOB
Address
Carer All Services
Carer Information preferences
Carer Other support
Carer Monitoring
Carer Years and Months caring
Professional Referrer details
Professional Referrer name and organisation
Preferred contact method(s)
Not used
Referral source
Relationship Support
Schooling/College
Schooling/College headline information
School/College Contact Details
School/College Address
More information about Young Carers
Does the young person have difficulties in any of the following areas?
Consent
Person Completing this form - Other
Thank You!
It looks like we already have your details - contact us if you want to update your records or are you need further support.Please contact us on contact@carersinbeds.org.uk  or call us on 0300 111 1919.
Consent Required
In order for Carers in Bedfordshire to support you we need you to consent to us using your data as described in our privacy policy. To continue with our registration you must select Yes. For further information please call us on 0300 111 1919.