Youth Services Referral Form

NOTE LOCATIONS: Safe Network service clients with 8 sites across the Upper North Island (including online). This includes Northland, Auckland, the Waikato and Bay of Plenty regions. If the client lives South or outside of these regions, please contact one of our partner agencies covering the rest of New Zealand - Wellstop (Lower North Island) and Stop (South Island).

For youth and adolescents 13-17 years old

This form takes approx. 10-20 minutes to complete including any uploaded files
You can save a draft of your referral form submission prior to completing (by selecting “save draft”) - this way you can leave and return to the form - we recommend this
Please answer all applicable questions - some questions are mandatory
We are here to help if you have any questions regarding this form or referral feel free to contact us, via our contact form on this site under “talk to us” or email us at info@safenetwork.org.nz or phone (09) 377 9898.

Please confirm that the information provided in this referral has been shared with the young person's legal guardian/s if they are under 16 years of age or with the young person if over 16 years of age:

Information provided in this referral has been shared with either the young person's legal guardian or the young person according to the age of the young person