*Please read all of the following information prior to referring in as we have recently changed the form*

Please ensure that you complete the form as fully as possible, and include explicit details of the caring role, because without this we cannot accept the referral. Include what tasks/emotional support the young person is providing, how often and how these impact on the young person’s life. Please only inform us of those tasks that are above and beyond what would be generally be expected of a person that age.

Complete one form per child/young person being referred, as the caring role and what they are undertaking will differ even within the same family. Note that we accept referrals for children and young people between the ages of 5-17 within Flintshire who provide support to family members either due to a physical disability, physical ill health, mental health, a learning disability or substance misuse.

Carers OVER 18:

Referrals will need to be made using the NEWCIS referral form

This is because the adult team at NEWCIS will deal with the referral, undertake any assessments needed and provide support. You can find out more about NEWCIS services here.

Examples of caring tasks and responsibilities for you to consider when referring in are:

  • Practical tasks, such as cooking, housework and shopping
  • Physical care, such as helping someone out of bed or aiding mobility
  • Emotional support, such as listening to, comforting, or providing company for the cared for person
  • Personal care, such as helping someone dress, wash or bathe
  • Collecting prescriptions and helping to give medicine
  • Helping someone communicate i.e. interpreting/signing
  • Looking after brothers and sisters i.e. taking a sibling to school, managing a sibling’s behaviour etc
  • Financial care such as dealing with bills, benefits or even working part-time
NEWCIS Young Carers Flintshire Referral Form

Referrer Details:

Child/Young Person Being Referred Details:

****Please note that NEWCIS Young Carers Service only covers Flintshire****
If multiple languages, please identify their primary language and if interpreter is required
Please see section above this form for examples of caring tasks and responsibilities prior to completing

Parent/Guardian Information:

If multiple languages, please identify their primary language and if interpreter is required
For an initial information pack, essential forms, and future correspondence.

Cared For Details:

Please consider if the young person has a caring role for more than one person
For example, environmental risk - access to property, hazards in or around property. Risk to self - safeguarding issues, self-harm, substance misuse. Risk to others - history of verbal or physical aggression, pets at the property.
Clear Signature