Young Carers NZ would like your help! If you are aged up to 18, 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).

* 1. How old are you?

* 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.

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

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

* 4. What gender do you identify with?

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

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

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

Acknowledgement: MACA-YC18 Used with permission. Copyright 2009 Fiona Becker, Saul Becker, Stephen Joseph & Steve Regel. All rights reserved. Developed for the Princess Royal Trust for Carers International Research and Evaluation, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham N67 2RD.