Young Carers and your Responsibilities Survey

Young Carers NZ would like your help! If you are aged up to 24, please tell us about the jobs you do at home to help your ill, elderly, or disabled family member(s). Having this information will help us support New Zealand’s young carers! Your information will be kept private (no one else will see it). Leave your details at the end of the survey to go in the draw for a $40 Warehouse gift card

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* 1. How old are you?

0-5 years old

6-10 years old

11-13 years old

14-18 years old

19+ years old

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* 2. Below are some jobs that young carers do to help. Think about the help you have provided over the last month. Please read each one and mark the box by clicking on it to show how often you have done each of the jobs in the last month.

Comment

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* 3. Please tell us who you assist (Mum, Grandma etc).

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* 4. What gender do you identify with?

Male

Female

Other

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* 5. What ethnic group(s) do you identify with?

Maori

NZ/European

Pacific (please specify)

Asian (please specify)

Other (please specify)

Specify Pacific, Asian, or other ethnicity

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* 6. What town or city do you live in?

Whangarei

Auckland Central

Auckland South

Auckland West

Tauranga

Hamilton

Gisborne

New Plymouth

Napier

Palmerston North

Wellington

Nelson

Greymouth

Christchurch

Queenstown

Dunedin

Invercargill

Other (please specify)

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* 7. Please share your contact information if you would like to join the Young Carers NZ network. You can also check out our Young Carers NZ Facebook page and connect with other young carers!

Name

Address

Post Code

Mobile/phone

Age

	Never	Some of the time	A lot of the time
Clean your own bedroom	Clean your own bedroom Never	Clean your own bedroom Some of the time	Clean your own bedroom A lot of the time
Clean other rooms	Clean other rooms Never	Clean other rooms Some of the time	Clean other rooms A lot of the time
Wash up dishes or put dishes in a dishwasher	Wash up dishes or put dishes in a dishwasher Never	Wash up dishes or put dishes in a dishwasher Some of the time	Wash up dishes or put dishes in a dishwasher A lot of the time
Decorate rooms	Decorate rooms Never	Decorate rooms Some of the time	Decorate rooms A lot of the time
Take responsibility for shopping for food	Take responsibility for shopping for food Never	Take responsibility for shopping for food Some of the time	Take responsibility for shopping for food A lot of the time
Help with lifting or carrying heavy things	Help with lifting or carrying heavy things Never	Help with lifting or carrying heavy things Some of the time	Help with lifting or carrying heavy things A lot of the time
Help with financial matters such as dealing with bills, banking money, collecting benefits	Help with financial matters such as dealing with bills, banking money, collecting benefits Never	Help with financial matters such as dealing with bills, banking money, collecting benefits Some of the time	Help with financial matters such as dealing with bills, banking money, collecting benefits A lot of the time
Work part-time to bring money in	Work part-time to bring money in Never	Work part-time to bring money in Some of the time	Work part-time to bring money in A lot of the time
Interpret, sign, or use another communication system for the person you care for	Interpret, sign, or use another communication system for the person you care for Never	Interpret, sign, or use another communication system for the person you care for Some of the time	Interpret, sign, or use another communication system for the person you care for A lot of the time
Help the person you care for to dress or undress	Help the person you care for to dress or undress Never	Help the person you care for to dress or undress Some of the time	Help the person you care for to dress or undress A lot of the time
Help the person you care for to have a wash	Help the person you care for to have a wash Never	Help the person you care for to have a wash Some of the time	Help the person you care for to have a wash A lot of the time
Help the person you care for to have a bath or shower	Help the person you care for to have a bath or shower Never	Help the person you care for to have a bath or shower Some of the time	Help the person you care for to have a bath or shower A lot of the time
Keep the person you care for company (sitting with them, reading to them, or talking to them)	Keep the person you care for company (sitting with them, reading to them, or talking to them) Never	Keep the person you care for company (sitting with them, reading to them, or talking to them) Some of the time	Keep the person you care for company (sitting with them, reading to them, or talking to them) A lot of the time
Keep an eye on the person you care for to make sure they are alright	Keep an eye on the person you care for to make sure they are alright Never	Keep an eye on the person you care for to make sure they are alright Some of the time	Keep an eye on the person you care for to make sure they are alright A lot of the time
Take the person you care for out e.g. for a walk or to see friends or relatives	Take the person you care for out e.g. for a walk or to see friends or relatives Never	Take the person you care for out e.g. for a walk or to see friends or relatives Some of the time	Take the person you care for out e.g. for a walk or to see friends or relatives A lot of the time
Take brothers or sisters to school	Take brothers or sisters to school Never	Take brothers or sisters to school Some of the time	Take brothers or sisters to school A lot of the time
Look after brothers or sisters whilst another adult is nearby	Look after brothers or sisters whilst another adult is nearby Never	Look after brothers or sisters whilst another adult is nearby Some of the time	Look after brothers or sisters whilst another adult is nearby A lot of the time
Look after brothers or sisters on your own	Look after brothers or sisters on your own Never	Look after brothers or sisters on your own Some of the time	Look after brothers or sisters on your own A lot of the time