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:
We strongly encourage you to get vaccinated before you attend our programme. Please visit: www.covid19.govt.nz to book your vaccination now online or or phone 0800 28 29 26. It is free to book your vaccination.
It is mandatory for all staff, clients and visitors to sign into the Covid-19 Tracer register when entering our facility. We prefer that you do this using the Covid-19 Tracer APP using your mobile phone, however if you do not have a mobile phone, you will be required to sign-in manually.
We encourage all staff, clients and visitors to hand sanitise when entering our facility, and hand sanitiser is located at the entrance.
Depending on Covid-19 Restrictions, the Government may make face mask wearing mandatory.
Please note also that you may request a face mask from us at anytime if you prefer to wear one, irrespective of Covid-19 Restriction Levels
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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