My Time for Young Carers Form

Name(Required)

First Last

Date of Birth(Required)

Please note young person must be aged between 10 and 14 for a Young Carer Junior membership, or between 14 and 16 for a Young Carer Full membership

Address(Required)

Address Line 1 Address Line 2 Town/City Post Code

Contact Number for the Parent/Guardian(Required)

Contact Number for the Young Person (if aged over 14)

Email Address for the Parent/Guardian(Required)

Email Address for the Young Person (if aged over 14 and wanting to book online)

Preferred Venue(Required)

Rochdale Leisure Centre

Heywood Sports Village

Middleton Arena

Littleborough Sports Centre (over 14s only)

Please upload the PAR-Q form here unless a parent/guardian will be able to attend the site and complete it in person before the young person’s membership is activated

Max. file size: 63 MB.

Referrer Name(Required)

First Last

Please provide the name and contact details for the carer hub worker doing this referral in case of any issues or queries.

Referrer Phone Number(Required)

Referrer Email Address(Required)

Your Health

Your Culture

Your Community

Who we are

My Time for Young Carers Form