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Referring a young carer

Please read the eligibility criteria before submitting a referral. 
You can use our online form or download and complete the form to submit a referral. 

Young carers sitting on a sofa

For professionals making a referral 

Caring Roles Questionnaire

To help decide whether to make a referral to the Young Carers Service, the young carer can fill in the simple Caring Roles Questionnaire.

The overall purpose of this questionnaire is to help: 

  • young carers share with others what caring they are doing 
  • professionals better understand what the young carers are dealing with, assess if it is appropriate to refer them for additional support and provide information on the range of support young carers can access. 

Responses are scored.  If the young person and/or their family would like additional support, we recommend that those who score over 10 are referred to our service. 

The Caring Roles Questionnaire will also help provide the information you need to complete our referral form. You do not need to include the Caring Roles Questionnaire when sending a referral.

Guidance on using the Caring Roles Questionnaire  

The guidance includes a wide-ranging list of support services young carers can access that can be given to parents/guardians.   There are also feedback forms so young people and professionals can let us know if this tool is useful.  

The guidance pack includes:

  • The Caring Roles Questionnaire for young people (with feedback form)
  • Caring role questionnaire follow-up 
  • Services available to young carers (Bristol)
  • Services available to young carers (South Glos) 

Download the guidance pack 

Submission of referral

If you decide a referral is appropriate, you can do so by filling in our online form below or downloading the form and returning the completed form by post, marking it ‘Private and Confidential’, to:

Bristol and South Glos Young Carers
Carers Support Centre
The Vassall Centre
Gill Avenue
Fishponds
Bristol BS16 2QQ. 

Alternatively, you can send the form to us via email. Please use a secure email service to send to us. 

For any enquiries, please contact us on 0117 958 9980. 

On line referral form

Details of child/young person

*
*

Address

*
*
*
*

Does the child live in: *

*

Gender *

Ethnicity

White

Mixed

Asian or Asian British

Black or black British

Other ethnic group

*

Is an interpreter or signer needed?

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Details of parents/carers

Please indicate who the child/young person cares for (name and relationship to them) and the nature of the illness, disability or substance misuse affecting the person they care for. Please also include information about the family structure, e.g. who lives with them or has regular contact etc.

*
*
*

Address (if different from child/young person

*

Address (if different from child/young person

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Details of siblings

Sibling 1

Gender of sibling *

Does the sibling have caring responsibilities?

Sibling 2

Gender of sibling

Does the sibling have caring responsibilities?

Sibling 3

*

Gender of sibling

Does the sibling have caring responsibilities?

Sibling 4

Gender of sibling *

Does the sibling have caring responsibilities?

Sibling 5

Gender of sibling

Does the sibling have caring responsibilities?

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Child/young persons’ current family and home situation

Please include information about the family structure (including sibling): for whom the child/young person has caring responsibilities: the nature of the illness, disability or substance abuse affecting the cared-for person.

Caring Tasks undertaken by child/young person

Please tick the caring tasks that the child/young person does regularly to help the person they care for.

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Impact of caring responsibilities on child/young person

Please tick all that apply:

Please tick the boxes that best describe the child/young person and how their caring responsibilities impact them. Are they:

*

School

*

Address

*
*
*
*

Is the school aware of the child/young person's caring responsibilities? *

Social care (Children's and adult's)

Is the child/young person a Child in Need (CIN) or on a Child Protection Plan (CP)

Does the child/young person or family have any support from social care services? *

Address

Address

Other services working with the family

Please give the details of any other services or organisations already working with the family (e.g. social services, community care, mental health professionals, GP, EWO, CAMHS, youth projects etc.)

Address

Address

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*

Details of referrer (if different from those preceding)

*

Address

*
*

Has the family given permission for the referral to be made to Young Carers and their data to be stored on a secure database for referral purposes only? *

If no, we will not be able to process the referral until consent has been given.

Other comments

Consents

*

See our Privacy Page

*
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“The support has made such a difference. Kierah now feels part of something that is rewarding. It gives her a break from caring and she meets others in similar situations; so, she knows she’s not alone.”   

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