Carers Mailing List

Carers Mailing List

As part of the regional carers strategy ‘Caring for Carers’, the Western Trust will keep a mailing list of informal (unpaid) Carers.

The mailing list will be managed in line with General Data Protection Regulations. Personal details will be confidential and not passed on to any other organisation.

What is the purpose of the Mailing List?

The Carers Mailing List will give the Western Trust more information about the numbers of Carers, their age profile and who they are caring for.

Twice a year the Carers support team issue a Carers Newsletter (April and September). From time to time the Carers Support Co-ordinator will send out other relevant information about carers issues or events, which will help to support you in your caring role.

How do I sign up?

Sign up to the Carers Mailing List by filling out the consent form below.

Consent for Western Trust Carers Mailing List

Title

Mr

Mrs

Miss

Ms

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Race/Ethnic Origin(Required)

White

Bangladeshi

Black African

Black Caribbean

Black Other

Chinese

Filipino

Indian

Irish Traveller

Pakistani

Mixed Ethnic Group

Other

Is your first language English?(Required)

Yes

No

Consent(Required)

I agree to my details being kept on the Western Trust Carers Database

Date(Required)

MM slash DD slash YYYY

Information about the person you care for

So that we can make sure information being sent to you is relevant, we need some information about the person you care for

Age(Required)

0-18

19-64

65 and over

If under 18, please provide Date of Birth(Required)

MM slash DD slash YYYY

Please tick all that apply to the person you care for(Required)

Learning disability

ASD

Physical disability

Dementia

Arthritis

Diabetes

Alzheimer's

Heart condition

CVA/Stroke

Kidney disease

MS

Parkinson's disease

Old and frail

Downs Syndrome

Brain injury

Mental health

Other

If 'Other', please specify(Required)

Download and print the Carers Mailing List.