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Home
About
Services
Training
- Introduction to Working with Young People and Substance Issues
News
Publications
- Annual Report
- Professional Resources & Papers
Membership
- Membership Application
- Associate Membership Application
Contact
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

Donate

Remote Youth Program Referral

Child/Applicant Information
Last Name*
First Name*
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Intersex
Culture*
- Aboriginal
- Torres Strait Islander
- Aboriginal & Torres Strait Islander
Preferred Language*
Applicant Mobile Number
Community*
Has the young person previously attended CAAPS*
- Yes
- No
Parent/Guardian Information
Is the young person in the care of the Minister?*
- Yes
- No
Parent/Guardian Name*
Relationship to Applicant
Phone Number
Substance Use Details
What substances is the young person using?*
How often does the young person use substances?*
- Daily
- Weekly
- Monthly
- Rarely
Referral Information
Who is making the referral?*
- Myself
- Family/Friend
- Organisation
Are you over 16 years of age?*
- Yes
- No
As you are not over 16 years of age, you will need a Parent/Guardian or Referral Service to complete this form.
Referring Service*
Contact Name*
Contact Number*
What is the reason of the referral?*
Consent
I give CAAPS permission to take photos and videos of me during the Youth Remote Program*
- Yes
- No
I give permission for the following:*
- I agree to participate in the Youth Remote Program
- I authorise my details be collected and stored by CAAPS and Government databases for reporting purposes
I give CAAPS permission to take photos and videos of my child during the Youth Remote Program*
- Yes
- No
As parent/guardian of the applicant, I give permission for the following*
- I have been given information about this referral and agree for my child to be referred to the CAAPS Youth Remote Program
- I hearby authorise information regarding my child's background to be collected and stored on the CAAPS and Government databases for reporting purposes only
As the Referral Service, I confirm the Parent/Guardian of the applicant have given permission for CAAPS to take photos and videos during the Youth Remote Program*
- Yes
- No
As a Referral Service, I agree to the following:*
- We have provided information regarding the Youth Remote Program to the applicant as well as their Parent/Guardian
- The Parent/Guardian have authorised for the applicants details be collected and stored on CAAPS and Government databases for reporting purposes
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CAAPS Aboriginal Corporation
Address: 60 Boulter Road Berrimah NT 0828
Freecall (NT only): 1800 894 800
Phone: (08) 8922 4800
Business Hours: Mon-Fri 8AM-4PM

QIC accredited since 2015, certified in 2021

We acknowledge the traditional owners and custodians of country throughout Australia and their continuing connection to land, sea and community. We pay our respects to them and their cultures, and to their elders both past and present.

CAAPS Aboriginal Corporation is committed to acceptance diversity and eliminating all forms of discrimination in the provision of CAAPS services. CAAPS welcomes all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation and gender identity.

Photograph Disclaimer: These pages may contain images of and reference to both living and deceased Indigenous people from diverse cultural backgrounds and communities. Please contact CAAPS if you have concerns with any material on this website. If you are in mourning or have sorry business, you can hide these images while viewing the website.

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© CAAPS 2024 | Website by Refuel Creative

We are currently experiencing technical difficulties with our online referral system.

For AOD referrals please contact (08) 8922 4852 or intake@caaps.org.au
For Youth Services referral please contact (08) 8922 4859 or ys.intake@caaps.org.au
For Homelessness Outreach Support referrals please contact (08) 8922 4823 or hos@caaps.org.au
For Family Support Services referrals please contact (08) 8922 4823 or fss.team@caaps.org.au

DISCLAIMER

These pages may contain images of and reference to both living and deceased Indigenous people from diverse cultural backgrounds and communities. If you are in a period of grieving, we recommend hiding images on this website.