Register for a Carers Emergency Card | Rhondda Cynon Taf County Borough Council

Details for Cared for Person
Name

First name

Last name
House name / number
Street name
Town
Postcode
Home Telephone no:
Mobile no:
Date of Birth:
Please give us physical and medical details and needs of the person you care for to enable is to provide correct support in an emergecy.

Emergency Contacts
One of the two people you list below would be the first person that Carerlink will contact in the event of an emergency. It is best to make sure these contacts are also keyholders or have immediate access to a key.
Contact 1
Name

First name

Last name
House name / number
Street name
Postcode
Mobile no:
Telephone no - Daytime
Telephone no - Evening
Telephone no - Weekend
Relationship to Person Cared for:

Emergency Actions
Please give details of the actions you would like Carerlink to take in the event of an emergency:
Access
Are there any difficulties in gaining access to your home (e.g. animal, security systems etc) and if so is there someone that could assist with access?

Assistance
If you would like any assistance in completing this form or if your details change, please contact the Carers Support Project on the Freephone Carersline: 08081001801
Declaration
The information provided in this form will be treated confidentially and stored on secure recording systems. We will only share your personal information with your consent, unless the law required us to do so (and is in keeping with the Data Protection Act) This enables agencies involved to provide a prompt, efficient and appropriate service to meet your needs. I am happy for Rhondda Cynon Taf County Borough Council to store or share my information as detailed above
Please type full name: