1. A service supporting
people who care
Photo: Timm Sonnenschein
for a relative
or friend
Organised by
the Birmingham
Buddhist Centre Photo: Timm Sonnenschein

2. This leaflet gives details of short
breaks run by the Birmingham
Buddhist Centre in partnership
with Birmingham City Council,
(Adults & Communities Directorate)
who provide the funding.
The aim is to help carers from Birmingham
manage stress and to promote their health
and wellbeing.
The breaks offer you a chance to take time out
from your caring responsibilities in the How to apply
company of other carers. Each break has a
Complete the application form opposite,
programme of activities which help you
detach it and send to the address shown.
recharge your batteries and give you ideas and
skills you can use at home. We will invite you to the first available weekend
when you reach the top of the waiting list.
Activities include yoga, meditation, massage,
walks but not all of these on every weekend or Six weeks before the break, detailed information
about what to bring and how to confirm your place
day. will be sent to you. If you have to turn down the
The weekends and days are provided free of invitation or cancel the place, we will offer you the
next available weekend. Our website also has more
charge to carers and include transport from the
information: www.livingwellworkingwell.org.uk
Buddhist Centre, accommodation, activities
and all meals. You qualify if you are a relative or For more information about the breaks,
friend caring for an adult or child who has a please call Birmingham Carers Centre:
disability or long term health problem and who
lives in Birmingham. There is no religious
content to the weekends. 01 21 2 6 2 3 0 3 6
The weekend breaks start on Friday The venues: Charney Manor
afternoons, meeting at the Birmingham A grand and ancient
Buddhist Centre in Moseley and travelling by Offa House country house with lovely
coach to the venue, returning late afternoon on A handsome house in a gardens, set in an
the Sunday. If you need a single room, we can village outside Oxfordshire village.
probably help you, otherwise you may to need Leamington Spa. Some Most rooms ensuite.
rooms ensuite. About 1 Located about 2 hours
to share with one other carer.
hour from Birmingham. from Birmingham.
“I didn't really know “It comes at a time
Photo: Timm Sonnenschein
how much I really when I most needed
needed this experience a break and I can
but it has helped me so now face the next few
much. I am so grateful months feeling positive
to everyone.” and refreshed.”

3. Application Form
Section 1 - Start here B. Priority need
Do your caring responsibilities take Yes
up a lot of your time and energy? No
Have you been on one of these Relaxation and If the answer is yes, we may be able to offer you
Stress Management weekend breaks before? another break with several weeks notice. We are
No - Please complete sections 2 - 4. aiming to prioritise support for carers who have the
greatest need. To help us with those decisions please
Yes - Please complete sections 1 - 4. answer the questions below.
There are two ways of applying to attend another Are you the only family member / friend Yes
break if you have already been on one. giving care to the person you look after? No
A. Late availability Do you have health problems which make
We always have a few spaces for carers who can take it more difficult for you to care, or are Yes
a place at very short notice (i.e. a week beforehand) caused by your caring responsibilities? No
I have been on one of these breaks before. Does the person you care for have
Please put my name on the late availability list. challenging behaviour? (such as may be Yes
caused by a learning disability, dementia No
or severe mental health problem)
Section 2 - About you Section 3 - About the person
_________________
that you care for
First Name:
Last Name: _________________ Their name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_______________
Address: __________________
__________________ Relationship to you: _ _ _ _ _ _ _ _ _ _ _
__________________ (e.g. they are YOUR mother, son, friend)
Post Code: _ _ _ _ /_ _ _ _ Their address: (only if its different from yours)
Telephone No.: _______________ ____________________
____________________
Mobile No.: _________________ ____________________
Email: ___________________ _________
Their date of birth:
Date of birth: _ _ _ _ _ _ _ _ _ Sex: _ _ _ _
Why they need care:
Do you have any special communication needs?
(such as BSL, Interpretor, Visually impaired etc) ____________________
____________________
______________________ ____________________
______________________
______________________ (e.g. mental health problems, learning or
physical disability)
Ethnic Origin: _______________
(This optional question won’t affect your application)
A few more questions overleaf >

4. Section 4 - More about you Please indicate the kind of room you need
(eg: because of medical needs)
Please give details of someone we can contact in
an emergency while you are away with us: Please tick any that apply:
Name: __________________ I need a ground floor room
__________________ I need a room with an en ensuite bathroom
Tel. No.: _________________ I need a single room
If you want to come with another carer and would
Is there anything else we need to know to ensure like to share a room with them please give their
your comfort and safety (eg: mobility problems) name. Note: this carer needs to fill out their own
application form.
______________________
______________________ Name of carer I would like to share a room with:
______________________ ______________________
______________________ ______________________
______________________
______________________
______________________
______________________
______________________ Please sign below to confirm that the
Do you have any special dietary requirement?
information you have given is correct.
(eg: vegetarian, vegan, wheat-free, no fish. Signed:
Please be specific – eg vegetarian but no eggs
so that we can make sure your needs are met.)
______________________
______________________
______________________ Date: _________________
Our website has more information: www.livingwellworkingwell.org.uk
If you have any questions about Please send this completed form to:
these Carers Breaks, please call Carers Breaks
the Birmingham Carers Centre: Birmingham Buddhist Centre
0121 262 3036 11 Park Road
Moseley
Birmingham
Data Protection Statement
B13 8AB
Birmingham Buddhist Centre and Birmingham
City Council follow the Data Protection Act 1998 Printed by
when using your personal information for booking Central Print,
these breaks. For more information, visit Birmingham, on
www.birmingham.gov.uk/privacy 100% recycled paper.
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