Apply to join the Family Carers’ Email Network

1. About yourself

Your First Name *

Your Last Name *

Email Address *

Phone Number

Gender

Female Male Transgender Non-Binary Other Unknown

Preferred Language

For example, English, Polish, Punjabi. Please leave blank if you do not wish to disclose. We collect this information as it helps to ensure we are inclusive, and we use it in our funding bids which allow the family carer email network to continue.

Ethnic Background

Please pick from the drop down next to which box best describes your background. Please leave blank if you do not wish to disclose. We collect this information as it helps to ensure we are inclusive, and we use it in our funding bids which allow the Family Carer Email Network to continue.

Getting the Challenge newsletter

Please tick here if you WOULD LIKE to sign up to receive our ‘Challenge’ newsletter by email twice a year.

2. About your family member with challenging behaviour

Relative's First Name *

Relative's Last Name *

Relative's Date of Birth

Relative's Gender

Relationship to you

What level of Learning Disability does your family member have? *

NB this network is only for people whose relative has a severe learning disability

Does your family member have a diagnosed syndrome/condition?

E.g. ASD, Down Syndrome, Smith Magenis etc

What level of spoken communication does your family member have?

Where does your family member live?

Type of challenging behaviour – Please pick any behaviour(s) your family member displays

Consent to join Family Carer Email Network *

By submitting this form you agree that the information is accurate and that you are happy for us to hold this information on file and to contact you again in the future.

The information you share with us will be held on a secure database and used for the purpose of administering the CBF Email Network. We do not share or sell our data to any third party. You can unsubscribe at any time by emailing: network@thecbf.org.uk We may contact you for further information about your relative to ensure the Email Network will be the best support for you. We can provide a list of other forums on request, as there are other support networks which might be more helpful for you and your relative. The network is moderated by the Email Network Coordinators at the CBF, who anonymise messages and replies and circulate them to the network. We will send you an email to let you know when your address has been added to the email network. To send a message to the network, email network@thecbf.org.uk