What if registration

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What if registration

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Cared for information

This service is a free service, funded by Cambridgeshire County Council and Peterborough City Council, to look after adults with care needs during an emergency involving their family carer. If the person you look after lives in Cambridgeshire or Peterborough, you can register your What If? Plan with us and apply for an Emergency Card. It is important before you complete this form that you have obtained permission from the person you care for, that they consent for their information to be shared with us. This also includes consent from any nominated contacts and key-holders you provide us. Questions with red boxes are mandatory.

Before completing please review the Caring Together privacy policy.

Who's completing the form?

Are you completing this for yourself or someone else?

MyselfSomeone else

Where did you hear about this service?

Your name

Your contact details

Organisation (if relevant)

Carer details

Title

First name

Last name

Address 1

Address 2

Town

County

Postcode

Email address

Telephone: home / mobile

Date of birth (dd/mm/yyyy)

GP Surgery

I am happy to let my GP know that I am a carer

Information about the person you look after (or care for)

Title

First name

Last name

Address 1

Address 2

Town

County

Postcode

Email address

Telephone: home / mobile

Date of birth (dd/mm/yyyy)

GP Surgery

Nominated contacts

Nominated contact

Nominated contact first name

Nominated contact second name

Contact Number to be used in case of an emergency

Nominated contact tel: home / mobile

Nominated contact tel: work

Keyholder information

Additional keyholder

Additional keyholder first name

Additional keyholder last name

Contact Number to be used in case of an emergency

Additional keyholder tel: home / mobile

Additional keyholder tel: work

Other information

Is there anyone under 13?

Is there a key safe?

Care agency name

Care agency contact number

Please register my What If? Plan for the emergency service and send me an emergency card. I am happy for you to record and use the information to provide me with this service, including updates and communications on this service.

I agree

I confirm that I have discussed the What If? Plan with my nominated emergency contacts and additional keyholders and that they consent that Caring Together will hold their details for this purpose.

I agree

I will notify you of changes to the plan as they arise.

I agree

I confirm that the person I look after is aware that I have made this plan, agrees to register with the service and gives consent that Caring Together will hold their details for this purpose and that in the case of an emergency these details might need to be shared with relevant professionals for the purpose of arranging support

I agree

Please indicate below if you would like to subscribe to the following:

Carers magazine mailing list

Inside News – our regular enewsletter

Responsible person

Responsible person first name

Responsible person last name

Contact Number to be used in case of an emergency

Responsible person tel: home

Responsible person tel: work

Responsible person tel: mobile

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Contact Information