Registration for Adult Carers

To qualify to register with us, either you or the person you care for, must live in the London Borough of Enfield.

Tell us about you, the person you care for and how you help that person.

Salutation / title *

First name *

Last name *

Your email address *

Your mobile phone number *

Your home phone *

Your date of birth *

Your gender *

Your ethnicity *

Religion *

Do you have a disability? *

Your main disability, if any *

Would you like some help and support to improve your own health and wellbeing? *

House number & street name *

Postcode *

Name of the person you care for *

Address of the person you care for *

Date of birth of the person you cared for *

What is the gender of the person you care for? *

Your relation to the person you care for *

Main disability of the person you care for *

Secondary disability of the person you care for

Hours per week caring *

Type of care you provide *

Number of people you care for *

Are there children and young people, aged 5-18, who are helping with your caring role? *

Would you like to be given some information about having a Carers Assessment, which may help your caring role? *

Where/how did you hear about Enfield Carers Centre? *

What support is required? *

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Register with us to use our services, keep up to date and receive useful emails.