Referral to Reach Out And Relax

Please use the form below, or download the attached form to record information about a child or young person who is seeking support through the Reach Out And Relax (ROAR) program.

How to complete and submit this form

This form may be completed by:

  • youth – able to self-refer
  • a parent or carer
  • a friend or family member
  • a teacher, youth/family worker or other professional who is working with the child/young person
  • people in the local government areas of Balranald, Wentworth, Berrigan, Hay, Conargo, Deniliquin, Wakool, Corowa, Murray, Jerilderie, Urana, Murrumbidgee, Narrandera, Wagga Wagga, Lockhart, Leeton, Temora, Griffith, Carrathool, Coolamon, Cootamundra, Gundagai and Junee.

There are two steps to complete and lodge this form:

  1. Complete the ROAR referral form below.
  2. Please complete all required fields.

Complete form

You can save a partially completed form to continue at a later date if required.