Please fill out the online form below, by filling in each section and clicking NEXT once you have completed each part.
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It is essential that all known risks are disclosed whether current or previous.
Please disclose all current and past risks and hazards known about the client:
It is mandatory for all clients and visitors to sign our visitor register when entering our facility.
We require all staff, clients and visitors to hand sanitise when entering our facility, and hand sanitiser is located at the entrance.
We may require you to wear a face mask when attending our programmes. This is not limited to only Government restrictions (if applicable) as we maintain our own health and safety policies and procedures. We may refuse you entry to our programmes if you refuse to comply with any request to wear a face mask.
Please note also that you may request a face mask from us at anytime if you prefer to wear one to maintain your own wellbeing
Please note that this person will also be the first point of contact in an emergency.
Please provide a second point of contact in case we are unable to reach the primary contact in case of emergency.
To complete this referral, please hit "Send Referral Now"
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