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Family carer membership

Family Carer membership form

This form is to join our membership if you are a family carer who cares for an adult with learning disabilities, including autism. (If you also work for an organisation or a practitioner, please share this with us at the end of the form).

Name(Required)
Address(Required)
In what capacity are you completing this form?(Required)
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If you are a family carer please tick the one that applies to you?(Required)
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Please note: Your personal information will only be used to process your requests, to provide you with our services, and to provide you with information relating to our services and all other services which we think you may be interested in. We will only share your information with other organisations if you have given us permission to do so.
Level of interest/involvement (tick all relevant boxes)
As well as sharing items of interest with you, we also welcome involvement from our members. Please indicate below what you would be willing to be involved in.
The following questions are optional but would really help to ensure the lived experiences and voices of our families informs and influences the future landscape and opportunities for people with a learning disability and autism and their families in Essex.
Where does the person with a learning disability and or autism live?
What package of support does your family member receive?
What does your family member do during the day?
We know often families may be caring for or supporting more than one person for example another son/daughter with a disability, parents, spouse, grandchild, sibling.
Please indicate below if you care for more than one person.
Thank you for taking the time to sign up for our network, strengthening the voice of our families.
TO DISCUSS HOW WE CAN SUPPORT YOU CALL 07876 025480 | INFO@ESSEXCARERSNETWORK.CO.UK
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E: info@essexcarersnetwork.co.uk

T: 01255 554029

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