Make a referral.

Consent

By completing this referral, you are consenting for Winchester & District Young Carers to hold the information on this form on a database which is shared with the Hampshire Young Carers Alliance.

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Young Person

(Please give as much detail as you can)
(This can be physical and/or emotional)
(This can be positive and/or negative)
(This can be time-out, someone to talk to etc…)