Request: Changing Places key

Name of carer (required)

I have been trained in the use of equipment inside the Changing Place facility and I have read and understood the guidance. (required)

Yes

Carer's address (required)

Email (required)

Name of user (required)

User's address (if different to carer)

Does the user give consent for their benefit information to be held by Chelmsford City Council? (required)

Yes No

Copy of DLA evidence

Evidence

Changing Places are only available to people receiving the higher rate Disability Living Allowance. If you can't upload the evidence now, you can send it by post, quoting the form reference number on your acknowledgement email.

Which address should the key be sent to? (required)

Carer's address User's address

Data protection declaration: We are a Data Controller for the purposes of data protection legislation. We hold and process all personal information in accordance with data protection legislation. For more information, you can read our privacy policy and privacy notices.