Carer
Registration

Hello! Thank for your registering with us. We need a bit of information about you and the person you care for. We will contact you shortly to complete your registration.

Carer Registration Form

Your Details

Fields marked with a * must be completed
Please enter date as DD/MM/YYYY
If you do not have a mobile number, you can call 0333 006 9711 and register with our contact team instead
If you do not have an email address, you can call 0333 006 9711 and register with our contact team instead

Information about your Caring Role

Please Enter Date as DD/MM/YYYY

Who you care for

Please enter date as DD/MM/YYYY
Adding your child’s name to the Birmingham Disabled Children’s Register will help our commissioners Birmingham Children’s Trust to understand more about the needs of children with disabilities and be able to plan better services in Birmingham in the future. Only Parent Carers and guardians can add their children to the register; it is completely voluntary and you can remove your details at any time.
Please allow 30 days to receive your Max Card from the date of your application.
Please enter date as DD/MM/YYYY
Adding your child’s name to the Birmingham Disabled Children’s Register will help our commissioners Birmingham Children’s Trust to understand more about the needs of children with disabilities and be able to plan better services in Birmingham in the future. Only Parent Carers and guardians can add their children to the register; it is completely voluntary and you can remove your details at any time.
Please allow 30 days to receive your Max Card from the date of your application.

Support Required

Contact Information