A service supportingpeople who care

for a relativeor friend

Organised by the Birmingham Buddhist Centre

Phot

o: T

imm

Son

nens

chei

nPh

oto:

Tim

m S

onne

nsch

ein

This leaflet gives details of shortbreaks run by the BirminghamBuddhist Centre in partnership with Birmingham City Council,(Adults & Communities Directorate)who provide the funding.

The aim is to help carers from Birminghammanage stress and to promote their healthand wellbeing.

The breaks offer you a chance to take time outfrom your caring responsibilities in thecompany of other carers. Each break has aprogramme of activities which help yourecharge your batteries and give you ideas andskills you can use at home.

Activities include yoga, meditation, massage,walks but not all of these on every weekend orday.

The weekends and days are provided free ofcharge to carers and include transport from theBuddhist Centre, accommodation, activitiesand all meals. You qualify if you are a relative orfriend caring for an adult or child who has adisability or long term health problem and wholives in Birmingham. There is no religiouscontent to the weekends.

The weekend breaks start on Fridayafternoons, meeting at the BirminghamBuddhist Centre in Moseley and travelling bycoach to the venue, returning late afternoon onthe Sunday. If you need a single room, we canprobably help you, otherwise you may to need to share with one other carer.

“I didn't really knowhow much I reallyneeded this experiencebut it has helped me somuch. I am so gratefulto everyone.”

“It comes at a timewhen I most needed

a break and I cannow face the next few

months feeling positiveand refreshed.”

Phot

o: T

imm

Son

nens

chei

n

How to applyComplete the application form opposite, detach it and send to the address shown. We will invite you to the first available weekendwhen you reach the top of the waiting list.

Six weeks before the break, detailed informationabout what to bring and how to confirm your placewill be sent to you. If you have to turn down theinvitation or cancel the place, we will offer you thenext available weekend. Our website also has moreinformation: www.livingwellworkingwell.org.uk

For more information about the breaks,please call Birmingham Carers Centre:

01 21 2 6 2 3 0 3 6The venues:Offa HouseA handsome house in avillage outsideLeamington Spa. Somerooms ensuite. About 1hour from Birmingham.

Charney ManorA grand and ancientcountry house with lovelygardens, set in anOxfordshire village. Most rooms ensuite.Located about 2 hoursfrom Birmingham.

Section 3 - About the person that you care for

Their name:

Relationship to you: (e.g. they are YOUR mother, son, friend)

Their address: (only if its different from yours)

Their date of birth:

Why they need care:

(e.g. mental health problems, learning or physical disability)

Section 1 - Start here

Have you been on one of these Relaxation and Stress Management weekend breaks before?

No - Please complete sections 2 - 4.

Yes - Please complete sections 1 - 4.

There are two ways of applying to attend another break if you have already been on one.

A. Late availability We always have a few spaces for carers who can take a place at very short notice (i.e. a week beforehand)

I have been on one of these breaks before. Please put my name on the late availability list.

Section 2 - About youFirst Name:

Last Name:

Address:

Post Code:

Telephone No.:

Mobile No.:

Email:

Date of birth:

Do you have any special communication needs?(such as BSL, Interpretor, Visually impaired etc)

Ethnic Origin: (This optional question won’t affect your application)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _

_ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ /_ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

B. Priority needDo your caring responsibilities take up a lot of your time and energy?

If the answer is yes, we may be able to offer youanother break with several weeks notice. We areaiming to prioritise support for carers who have thegreatest need. To help us with those decisions pleaseanswer the questions below.

Are you the only family member / friend giving care to the person you look after?

Do you have health problems which make it more difficult for you to care, or are caused by your caring responsibilities?

Does the person you care for havechallenging behaviour? (such as may becaused by a learning disability, dementia or severe mental health problem)

YesNo

YesNo

YesNo

Sex:

A few more questions overleaf >

Application Form

YesNo

Please send this completed form to:

Carers BreaksBirmingham Buddhist Centre11 Park RoadMoseleyBirminghamB13 8AB

Section 4 - More about youPlease give details of someone we can contact inan emergency while you are away with us:

Name:

Tel. No.:

Is there anything else we need to know to ensureyour comfort and safety (eg: mobility problems)

Do you have any special dietary requirement? (eg: vegetarian, vegan, wheat-free, no fish. Please be specific – eg vegetarian but no eggs so that we can make sure your needs are met.)

Please indicate the kind of room you need (eg: because of medical needs)

Please tick any that apply:

I need a ground floor room

I need a room with an en ensuite bathroom

I need a single room

If you want to come with another carer and wouldlike to share a room with them please give theirname. Note: this carer needs to fill out their ownapplication form.

Name of carer I would like to share a room with:

Please sign below to confirm that the information you have given is correct.Signed:

Date:

Our website has more information: www.livingwellworkingwell.org.uk

Data Protection Statement

Birmingham Buddhist Centre and BirminghamCity Council follow the Data Protection Act 1998when using your personal information for bookingthese breaks. For more information, visitwww.birmingham.gov.uk/privacy

If you have any questions about these Carers Breaks, please call the Birmingham Carers Centre:

0121 262 3036

Printed by Central Print,

Birmingham, on100% recycled paper.

Design by Shtig

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _