Carers Parliament 2019 - Delegate Registration Survey

The 7th Carers Parliament will be held on Wednesday 30 October 2019. The event will be held at the Central Halls in Edinburgh.

The event will begin begin with registration, refreshments and breakfast rolls from 9.30am (10am start) and will finish by 4pm.

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.

Filming and Photography
The Carers Parliament will be filmed and photographed. In registering for the event you agree to audio, video and photographic recording and give consent to this being used for the purposes of reporting the outcomes of the Carers Parliament and issues raised by carers in Scotland. This may include, for example, films being broadcast on the Carers Scotland YouTube Channel or images being used to publicise work around carers.

Question Title

* 1. Your name:

First Name

Surname

Question Title

* 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 for any young carer or disabled 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 carers with whom you will be attending.

Carer

Former carer

Support worker for the following 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.

Question Title

* 3. Your contact details:

Address 1: *

Address 2:

City/Town: *

Postcode:

Email Address:

Phone Number: *

Question Title

* 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)

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)

Question Title

* 6. What local authority do you live in?

Aberdeen City

Aberdeenshire

Angus

Argyll and Bute

Clackmannanshire

Comhairle nan Eilean Siar

Dumfries and Galloway

Dundee

East Ayrshire

East Dunbartonshire

East Lothian

East Renfrewshire

Edinburgh City

Falkirk

Fife

Glasgow City

Highland

Inverclyde

Midlothian

Moray

North Ayrshire

North Lanarkshire

Orkney Islands

Perth and Kinross

Renfrewshire

South Ayrshire

Scottish Borders

Shetland Islands

South Lanarkshire

Stirling

West Dunbartonshire

West Lothian