Unpaid Carers Covid-19 Grant

Section 1: Contact details
About the Carer
Section 2: Details of the caring situation
Cared for person's details
Section 3: Information about the request
(please complete this section detailing your request for: Therapy, Short Break, Building Skills or Other)
Section 4: Cost of the request
Please note: Crossroads Care Rotherham will need to see a quote for the cost of the request e.g. a written quote from the supplier, a web page etc and will then facilitate the purchase / payment for services or items. (No cash or vouchers will be exchanged)
Section 5: Benefits
Section 6: Equlity & Diversity Questionnaire
Equality data is carefully monitored to ensure that services are delivered fairly and non-discriminatory. The information you provide will be treated in the strictest confidence and is for monitoring purposes only and will not be divulged in anyway with any non-essential members of staff. NB. Provision of the information is completely voluntary and there is no compulsory requirement to provide this information, however the greater breadth of knowledge provided to us, the greater detail of analysis and feedback we can provide to auditors.
Disability Discrimination Act 2005
A person has a disability under the Disability Discrimination Act if he/she has a physical or mental impairment which has a substantial and long term diverse effect on his/her ability to carry out normal day-to-day activities. Long term means, has lasted, or is expected to last for 12 months.
Section 7: Carers declaration and consent
Carer declaration: In agreeing for details in this form to be submitted, you are confirming that: 1. All information provided is true and accurate; 2. All referenced adults’ consent to the collection, processing, sharing and secure storage of this information by Rotherham Metropolitan Borough Council / Crossroads Care Rotherham. 3. All adults consent to providing full information on how the grant has been spent if requested by Rotherham Metropolitan Borough Council /Crossroads Care Rotherham.
Crossroads Privacy Policy
We promise to keep your personal details safe. You can change how we contact you at any time by contacting us at info@crossroadsrotherham.co.uk or 01709 360272. To see how we protect and use your personal data read our Privacy Policy at https://crossroadsrotherham.co.uk/privacy-policy/