Carers Passport Request Form

Please use this form to register for your Carers' Passport. Please note, if you have lost your Carers’ Passport Discount Card and need a replacement you do not need to complete this form; Instead, please contact us on 01992 58 69 69. Please be aware it is taking longer than usual for you to receive your card due to the current health situation.

Please note: The following groups are not eligible for the Carers in Hertfordshire passport card: Foster parents, care workers/paid workers, kinship carers where the child does not have a disability or condition.

Basic details...

We can't proceed without a title

We can't proceed without your 'First name'

We can't proceed without your 'Surname'

We can't proceed without your 'email address'.

We can't proceed without your 'address details'

We can't proceed without your 'address details'

We can't proceed without your 'Postal town'

We can't proceed without your 'Postcode'

We can't proceed without your 'contact number'

Some personal details...

We can't proceed without your 'Date of birth'

We can't proceed without your 'Doctor's Surgery name'

We can't proceed without this information

Please tell us who you care for.

We can't proceed without this field completed

Invalid Input

/ / Please provide the Caree's DOB

Please provide the diagnosis of your Caree

Please tell us the nature of the care you provide.

Please tell us where you heard about the Carers in Herts discount passport or Carers in Herts.

Max file size: 16Mb
(File types accepted: jpg, jpeg, png, bmp, gif & docx)

We can't proceed without this information

We can't proceed until you acknowledge this.

Invalid Input