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Home
About
Who We Are
Our Work
Locations
Fees
FAQ
Our Team
Our Services
Therapeutic Services
ADHD Assessments
Neurodiversity Assessments
Sensory Processing Assessment and Intervention
Consultation / Supervision
Training
Corporate Wellbeing
DBT Programme
Contact Us
Bookings
Surfing the Wave
application form
Application Form
Name
*
First Name
Last Name
Date of Birth
*
Ethnicity
*
Current Address
*
Suburb
*
Email
*
Phone Number
*
Why are you interested in joining this group?
How did you hear about this group?
*
If you are making this application for yourself please press the Submit button now.
The next section is for Parents, Caregivers, Education or Support Service Personnel who would like to introduce a Rito (Young Person/Adolescent)
Name of Person Referring / Parent / Caregiver (if applicable)
First Name
Last Name
Your relationship to the Rangatahi (Youth/Young Adult))
Email (of Referrer / Parent / Caregiver)
Phone Number (of Referrer / Parent / Caregiver)
How do you think this programme will be helpful for the Rangatahi (Youth/Young Adult)?
Has the Rangatahi given consent for this introduction?
Yes
No
Is there any current risk to themselves, to others or from others?
Thank you!