Barnardo’s CareFree Young Carers’ Service Referral Form(for young carers living in Leicester/Leicestershire/Rutland only) This on line referral form is for young carers under 18 (in Leicester City) and under 19 (in Leicestershire and Rutland). Please complete as much of the form as you are able. We welcome referrals from any source as long as the family have given their consent to the referral being made. * = essential information Young carer's details Section 1 of 6 Young Carer's Surname:* * Young Carer's Address:* * Address line 2 Address line 3 Young Carer's Postcode:* * Telephone Numbers:* * Family Email Address: * Do the family wish to have a service? * Have the family consented to this referral being made? WE CANNOT ACCEPT A REFERRAL WITHOUT THE FAMILY’S CONSENT.