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Get In Touch

I am touching base on behalf of
Name
Email Address
I'd like to enquire about

This form should be used by external agencies to professionally submit a referral to Whatever. If this doesn't apply to you and you just want to make contact with Whatever for help, please select 'myself' in the above field.

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referrer details

Name
Agency
Contact Number
Email Address

client's details

Name
Date of Birth
Contact Number
Gender
Ethinicity

Referral

Has this young person talked to someone about this before?
Is this young person willing to talk to someone at Whatever?

Signed by

Referrer
Date
Young Person
Caregiver
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Want to support our mahi?

WHATEVER is a not-for-profit service that supports our local communities rangatahi/youth to be the best they can be, but we need your help to continue doing this!

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