Carer Card Application

To request a Carer Card we require you to provide the following information before we can process your application:

Do you live in Lanarkshire?*

YesNo

Are you a Carer already known to Lanarkshire Carers?*

YesNoDon't Know

If you are a carer and your are not already known to Lanarkshire Carers, we cannot issue you with a Carer Card and your application will not be processed. To check if you are known to us, please contact Lanarkshire Carers Centre: Hamilton on 01698 428090 or Lanarkshire Carers Centre: Airdrie on 01236 755550.

Alternatively, please complete our Online Self-Referral Form indicating Carer Card as a reason for referral and a member of staff will pick up with you in due course.

More information on the services provided by Lanarkshire Carers can be found on our website: www.lanarkshirecarers.org.uk

Name*

First NameLast Name

Address*

Street Address

Address

Town / City

Postcode

E-mail

Telephone Number*

Please select the relevant option*

New ApplicationRenewal of CardReplacement Card

Do you have access to a smartphone?*

YesNo

Has your caring role changed since your last card was issued?*

YesNo

Please tell us how your caring role has changed:

Photographic identification is required to process your Carer Card application. You can upload a photograph that you wish to use on your card below.

Please use a photograph that can be used to easily identify you, like a passport photograph. The size of your photograph must not exceed 2MB if you are uploading online. If you experience any issues uploading your photograph, please contact us on 01698 428090.

If you do not wish to upload a photograph at this time, please tick one of the other options below. We will contact you to advise how you can send us your photograph.

Photograph option*

I want to upload a photograph nowI will visit one of your centres and have my photograph takenI would like to use my existing photograph (renewal/replacement cards only)

Please upload your photo

All applicants must read and agree to the Carer Card Terms and Conditions before a card can be issued.

Declaration*

I have read and understand the Carer Card Terms and Conditions