Carer Registration Card Application

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

Do you live in Lanarkshire? *

Yes No

Are you registered with Lanarkshire Carers Centre *

Yes No Don't Know

To obtain a Carer Registration Card you must be registered as a carer with Lanarkshire Carers Centre. Please contact us on 01698 428090 / 01236 755550 to discuss your application further.

Alternatively, please complete our Online Referral Form indicating Carer Registration 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 Centre can be found on our website: www.prtlcc.org.uk

Name *

First Name Last Name

Address *

Street Address
Address
Town / City	State / Province
Postcode	Country

E-mail

Telephone Number *

Please select the relevant option *

New Application Renewal of Card Replacement Card

Photographic identification is required to process your Carer Registration 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 now I will send you a photograph by post I will visit one of your centres and have my photograph taken I would like to use my existing photograph (renewal/replacement cards only) I would like to speak to someone about my photograph

Please upload your photo

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

Declaration *

I have read and understand the Carer Registration Card Terms and Conditions