To join the register please print out the form below and fill in your details.

Please give us both your details and the details of the person you care for.

Joining form
About you About the person you care for
Your name Their name:




Your address: Their address (if different to yours):





Your telephone number: Their telephone number:



Your date of birth: Their date of birth:



Your first language: What disability or illness do they have?



Your ethnic origin: What is their relationship to you?



I understand that I may be sent information
as a result of being added to the Register		  
   
Signed:




 Date:

Please send your completed form to:

Carer Development Worker
Integrated Older People's Services
London Borough of Waltham Forest
FREEPOST LON 18236
LONDON  E17 5BR

There is no charge for sending your form to this address.