Surrey Young Carers < 18
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Give Carers a Voice Forum
North West Surrey Carers’ Forum
Wednesday 23
rd
January 2013
Booking Form
If you would like to attend the Carers’ Forum please complete this booking form. To help with arrangements please respond by Wednesday 16th January 2013.
Name
*
Address
*
Postcode
*
Telephone Number
*
Email Address
*
Email Address
*
Please tick the relevant box
I can attend
I am a carer
I am a former carer and ceased caring on (date)
I am a professional
I cannot attend but would like information about future events
I would like to have lunch
(A hot lunch is provided free of charge)
I have special dietary requirements
(please detail below)
I have no transport and require help with this.
Once we have received all transport requests, we will contact you after Wednesday 16th January to advise on the arrangements.
Parking:
Parking at the Holiday Inn is only available for disabled guests.
All others should park at the Victoria Way Car Park next door (GU21 6GH). We will give you a voucher for up to 6 hours’ parking on presentation of your valid Victoria Way car park entry ticket at the forum reception desk.
I am disabled and require on-site parking at the Holiday Inn.
Note: Holiday Inn Woking is fully accessible to people who use wheelchairs.
Do you have any other requirements to enable you to participate in the day? (e.g. hearing loops etc.)
You may attend one workshop. Places will be limited so please indicate your first and second choices: All workshops are subject to change without prior notice.
Workshop
Social care - helping carers navigate their way around self-directed support, supported self-assessment and other developments
First Choice
Second Choice
Mental health - future directions following the Public Value Review
First Choice
Second Choice
NHS Continuing Care – update on eligibility and assessment
First Choice
Second Choice
Parent carers – update on support, services and short breaks
First Choice
Second Choice
We may take photos during the event for publicity purposes.
We may take photos during the event for publicity purposes. Please tick the box if you do not wish to have your photo to be taken
Please return this form by Wednesday 16th January 2013, to:
Action for Carers (Surrey)
FREEPOST (SCE6731), Guildford, Surrey GU4 7BR
Tel no: 01483 302748 or email to
[email protected]
Places are limited and prior booking is essential. Please note that we can only confirm your place if you provide an email address or if you phone us. Do let us know as soon as possible if you find you are unable to attend so that the place can be offered to another person. In the event of being oversubscribed, priority will be given to carers.
If you would like to be put in touch with your local Carers Support Scheme please tick box. Indicate if you are already in touch with them. Yes/No
If you have any requirements not covered above please contact us on
01483 302748
or for any other queries, contact your local Carers Support Scheme:Carers Support Woking -
01483 727277
Carers Support Elmbridge -
01932 235770
Carers Support Runnymede -
01932 564446
Carers Support Spelthorne -
01784 444233
Data Protection Statement. Your details will be kept by us for the purposes of mailing out to you information, invitations, newsletters and from time to time seeking your views by questionnaire, etc. Your details are kept strictly confidential and will not be passed to any third party without your express permission except as allowed by law, including the Companies Act 2006. You have the right to know what personal data Action for Carers (Surrey) holds about you. You also have the right to have your data corrected or deleted. Please address any such requests to us in writing. Please note that if you are a member of Action for Carers (Surrey) the Companies Acts give the right to the public to inspect the Register of Members and take extracts from the register. Action for Carers (Surrey) must keep such information for not less than 10 years and the Data Protection Act does not apply to this information.
Processing
The data has been submitted.