Carers Parliament 2018 - Delegate Registration

The 6th Carers Parliament will be held on Wednesday 24th October. The event will be held at the Royal Botanic Gardens in Edinburgh.

The event will begin begin with registration, refreshments and breakfast rolls from 9.30am (10.15am start) and will finish by 3.45pm.

Please note: the event will be filmed and photographed. These will only be used to report on the Carers Parliament.

This form is to complete your delegate registration. It is to provide Carers Scotland with more information about you and about any support you may need to attend the Carers Parliament.

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* 1. Your name:

First Name

Surname

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* 2. I am:

Please note, This event is for carers and former carers only. This means people who provide unpaid care to family members, other relatives, partners, friends and neighbours of any age affected by physical or mental illness, disability, frailty or substance misuse.

if you are not a carer or former carer, and have therefore registered in error, please contact Carers Scotland on 0141 445 3070 or email rena.friel@carerscotland.org

NB: We do however offer the option of a young carer to bring a support worker if needed. If you are a support worker, please tick the box, "support worker" and in the text box please complete the name(s) of the young carers with whom you will be attending.

Carer

Former carer

Support worker for the following young carer(s)

Please complete your details below. If you have an email address it would be very helpful if you could provide this as it will save on administration and postage costs.

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* 3. Your contact details:

Address 1: *

Address 2:

City/Town: *

Postcode:

Email Address:

Phone Number: *

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* 4. If possible/available, could you please provide a mobile telephone number number to assist us on the day. This would simply be in the event of, for example, severe weather.

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* 5. Are you a carer representative on one of the following? (tick all that apply)

A health and social care partnerships/integrated joint board

On a local carers strategy group

On a local NHS public partnership group

A local carers forum

On a carers centre board or management committee

On a voluntary organisation's board or management committee

I am not a carer representative on any of these bodies

On another group (please specify)

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* 6. Scottish Parliamentary Constituency (please leave blank if you do not know and we will complete it)

Aberdeen Central

Aberdeen Donside

Aberdeen South and North Kincardine

Aberdeenshire East

Aberdeenshire West

Airdrie and Shotts

Almond Valley

Angus North and Mearns

Angus South

Argyll and Bute

Ayr

Banffshire and Buchan coast

Caithness, Sutherland and Ross

Carrick, Cumnock and Doon Valley

Clackmannanshire and Dunblane

Clydebank and Milngavie

Clydesdale

Coatbridge and Chryston

Cowdenbeath

Cumbernauld and Kilsyth

Cunninghame North

Cunninghame South

Dumbarton

Dumfriesshire

Dundee City East

Dundee City West

Dunfermline

East Kilbride

East Lothian

Eastwood

Edinburgh Central

Edinburgh Eastern

Edinburgh Northern and Leith

Edinburgh Pentlands

Edinburgh Southern

Edinburgh Western

Ettrick, Roxburgh and Berwickshire

Falkirk East

Falkirk West

Galloway and West Dumfries

Glasgow Anniesland

Glasgow Cathcart

Glasgow Kelvin

Glasgow Maryhill and Springburn

Glasgow Pollok

Glasgow Provan

Glasgow Shettleston

Glasgow Southside

Greenock and Inverclyde

Hamilton, Larkhall and Stonehouse

Inverness and Nairn

Kilmarnock and Irvine Valley

Kirkcaldy

Linlithgow

Mid Fife and Glenrothes

Midlothian North and Musselburgh

Midlothian South, Tweeddale and Lauderdale

Moray

Motherwell and Wishaw

Na h-Eileanan an Iar

North East Fife

Orkney Islands

Paisley

Perthshire North

Perthshire South and Kinross-shire

Renfrewshire North and West

Renfrewshire South

Rutherglen

Shetland Islands

Skye, Lochaber and Badenoch

Stirling

Strathkelvin and Bearsden

Uddingston and Bellshill

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* 7. Themed workshops

We will be organising a range of workshops and activities. Please rate your preferred options (1) most preferred topic through to (7) not interested in this topic.

	1 - Most preferred	2	3	4	5	6	7 - Not interested
1. Improving futures... support for young carers and the Young Scot Card	1. Improving futures... support for young carers and the Young Scot Card 1 - Most preferred	1. Improving futures... support for young carers and the Young Scot Card 2	1. Improving futures... support for young carers and the Young Scot Card 3	1. Improving futures... support for young carers and the Young Scot Card 4	1. Improving futures... support for young carers and the Young Scot Card 5	1. Improving futures... support for young carers and the Young Scot Card 6	1. Improving futures... support for young carers and the Young Scot Card 7 - Not interested
2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for?	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 1 - Most preferred	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 2	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 3	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 4	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 5	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 6	2. Dignity and respect...how can social security deliver better outcomes for carers and those they care for? 7 - Not interested
3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers?	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 1 - Most preferred	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 2	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 3	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 4	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 5	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 6	3. Healthy communities...how can integration and the new GP contract deliver better health and wellbeing for carers? 7 - Not interested
4. And the rest... innovating and offering better breaks for carers	4. And the rest... innovating and offering better breaks for carers 1 - Most preferred	4. And the rest... innovating and offering better breaks for carers 2	4. And the rest... innovating and offering better breaks for carers 3	4. And the rest... innovating and offering better breaks for carers 4	4. And the rest... innovating and offering better breaks for carers 5	4. And the rest... innovating and offering better breaks for carers 6	4. And the rest... innovating and offering better breaks for carers 7 - Not interested
5. Making it work....employment and employability for carers and young adult carers	5. Making it work....employment and employability for carers and young adult carers 1 - Most preferred	5. Making it work....employment and employability for carers and young adult carers 2	5. Making it work....employment and employability for carers and young adult carers 3	5. Making it work....employment and employability for carers and young adult carers 4	5. Making it work....employment and employability for carers and young adult carers 5	5. Making it work....employment and employability for carers and young adult carers 6	5. Making it work....employment and employability for carers and young adult carers 7 - Not interested
6. Equal recognition... a fairer deal for older carers	6. Equal recognition... a fairer deal for older carers 1 - Most preferred	6. Equal recognition... a fairer deal for older carers 2	6. Equal recognition... a fairer deal for older carers 3	6. Equal recognition... a fairer deal for older carers 4	6. Equal recognition... a fairer deal for older carers 5	6. Equal recognition... a fairer deal for older carers 6	6. Equal recognition... a fairer deal for older carers 7 - Not interested
7. Tour of Edinburgh Botanic Gardens	7. Tour of Edinburgh Botanic Gardens 1 - Most preferred	7. Tour of Edinburgh Botanic Gardens 2	7. Tour of Edinburgh Botanic Gardens 3	7. Tour of Edinburgh Botanic Gardens 4	7. Tour of Edinburgh Botanic Gardens 5	7. Tour of Edinburgh Botanic Gardens 6	7. Tour of Edinburgh Botanic Gardens 7 - Not interested

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* 1. Your name:

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* 3. Your contact details:

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* 4. If possible/available, could you please provide a mobile telephone number number to assist us on the day. This would simply be in the event of, for example, severe weather.

Question Title

* 5. Are you a carer representative on one of the following? (tick all that apply)

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* 6. Scottish Parliamentary Constituency (please leave blank if you do not know and we will complete it)

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* 7. Themed workshopsWe will be organising a range of workshops and activities. Please rate your preferred options (1) most preferred topic through to (7) not interested in this topic.

* 7. Themed workshops

We will be organising a range of workshops and activities. Please rate your preferred options (1) most preferred topic through to (7) not interested in this topic.