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Sowers

WHAT HAPPENS IN THE SOWERS PRIMARY SCHOOL GROUP SESSIONS?

Sowers

A month in the life of Sowers

Referral Form

  • Referral Form

    EXTERNAL AGENCY CLIENT REFERRAL FORM

    Date of Referral:

    CLIENT

    Name of Client*

    Date of Birth*

    Address :

    Sex

    Contact Details

    Ethnicity

    Iwi

    Occupation :

    PARENT/CARE GIVER/FAMILY INFORMATION (if appropriate):

    Name

    Is the family aware of this referral?

    Address

    Contact details:

    Relation to client:

    Details of family members:

    HOW DID YOU HEAR ABOUT THE SOWERS TRUST:

    REFERRAL DETAILS

    Organisation:

    Address:

    Worker’s name:

    Contact details:

    Email:

    SERVICES CURRENTLY SUPPORTING THE WHANAU:

    Please specify and give brief summary:

    Please highlight services that may be helpful to you

    Is Oranga Tamariki involved with this whanau?

    Are you aware of any Police involvement?

    BRIEF HISTORY AND ANY EXPECTATIONS OF THE SOWERS TRUST:

    PLEASE TICK THE BOX IF IT IS OK TO TAKE PHOTOS/VIDEOS TO BE USED FOR PROMOTIONAL REASONS

    This consent form sets out the choices you have when you engage with Sowers. It also explains how your personal information will be used. If you do consent to your information being shared, you have the right to change your mind at any time.

    Privacy Statement for Collection of Personal Information

    Sowers trust is funded by Oranga Tamariki to provide support to young people and whanau.

    I understand and agree that:

    1. Information may be shared with the agencies that are also working with me.

    2. I can decide to decline support from Sowers at any time.

    3. Information about my whānau/family’s will be used for statistical purposes, but only information that does not identify any member of my family/whānau.

    4. The Sowers Trust worker has explained the complaints process to me.

    5. Agencies will only share my information with other agencies involved in this case. They will follow their agency’s confidentiality code.

    6. My family/whānau can choose to bring support people to meetings.

    7. I can make suggestions about the meeting venue, cultural protocol to follow at the meeting, and any other needs I may have, such as translators, disability access, etc.

    8. I understand how my whānau/family’s personal information may be used.

    9. I am entitled to a copy of this consent form.

    Client Signature:

    Date :

    If you would like to discuss a referral, arrange a visit or require any further information, please contact our referral coordinator on 09 5380050 or referrals@hcc.co.nz.

    Address

    The Sowers Trust

    The Picton Centre,

    120 Picton St,

    Howick, Auckland, 2014

    www.thesowerstrust.com 

    09 5380050

    PO Box 38360

    Howick, Auckland, 2014


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