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REFERRALS

Whanake Youth Logo_Web-06.png

If you have a young person to refer, please complete the attached form (or below) and send form to us at hello@whanakeyouth.org.nz

Client Details

Who is the referral for?

First Name

Last Name

Preferred Name

Birthday

Gender

Pronouns

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Thank you for the submission

ADDRESS

HQ | YOUTH SPACE

548 Main Rd Stoke.

Stoke, Nelson 7011

(behind Stoke Memorial Hall)

OFFICE | HQ

548 Main Rd Stoke.

Stoke, Nelson 7011

(behind Stoke Memorial Hall)

HOURS

M | T | Th 3-7PM

3-5PM

Alternate Weeks

M | T | W 4-6PM

| Th 3-5PM

M-F

8:30AM - 5:30PM

CONTACT

021 154 2369

hello@whanakeyouth.org.nz

Welcome to Whanake Youth

SUBSCRIBE

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