About the young person
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This form asks Essex Young Carers Service to offer support to someone under 18 who provides or intends to provide care for a family member or another person (except where that care is paid for or as voluntary work), or a young adult carer aged 16 - 24 years.

It can be filled in by the young carer, anyone from their family or someone working with the family such as a teacher, GP, social worker, youth worker or voluntary sector provider.

This referral will allow Essex County Council to talk to the young carer and those they care for about how we might be able to get help for them with their caring, education, health or wellbeing.

Before you begin you'll need:

  • About 15 minutes to fill in the form
  • Contact information for the young person
  • Information about the young person such as school attended, health needs and their home situation
  • Your contact details (if you're the referrer)

What happens to my information?
We’re collecting information about you and the young person so that we can arrange suitable support. We will not share it with anyone unless the law says we must. To find out more about the information we hold and why we may need to share it, please read our privacy policy


Young person's contact details

Date of birth *
Date of birth

School / work details

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