Referrals

Are you a…

New Applicant
Returning Applicant

Please select which of the following best describes you.

I am an active client at SOTCS wanting to join another program
I am a former client wanting to rejoin SOTCS
Previously applied for a program at SOTCS but never joined
I am a new client wanting to join program

Contact Info

parent/guardian name

Name*

First Name Last Name

Gender*

Male
Female
Transgender
Other

Birthdate*

Self Identify*

Name of Nation

i.e Sḵwx̱wú7mesh, Cree, Mi'kmaq

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

How would you like to be contacted? (phone, e-mail, etc.)*

Type of Referral

Self-Referral – How did you hear about Spirit of the Children?

Family
Friends
Spirit Staff
Other

Community Referral – Insert name of organization who referred you to Spirit of the Children

Spirit Staff Referral – Insert name of staff member that referred you

You are not required to fill this if community referral, i.e. other organization or social worker.

MCFD Referral – Fill in MCFD worker’s info

Name

First name Last name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Office Number

Select Program Choices (up to 3 max)

Early Childhood Development

Family Development Program

Family Strengthening Worker
Fatherhood & Motherhood is Sacred
Addiction Services
Emotional Health & Well-Being
Men's Circle
Women's Circle
Traditional Kitchen
Cultural Connections
Elder's Tea and Bannock Club

Youth Program

Iskwew Girls Group (10-15yrs)
Youth Drop in (13-18yrs)
Tweenies Group (7-12yrs)
Napew Boys Group (10-15yrs)
Youth Enhancement Worker Program (7-18yrs)
Cultural Teachings (7-18yrs)
Peers program (13 - 18yrs) New West
Busy Bears (6-8years) New West
Thunderbird Explorers (9-12years) New West

Housing Support Program Appointment-basis only except for Tuesdays. Please call 604-524-9113.

Reason for Referral*

Signature

Agreement*

I have read and agree with this referral

Fill in Name of Children (if any)

First Name

Last Name

Gender

Boy
Girl

Birthdate

Self Identify

Is child in care?

Yes
No

Contact Info

Type of Referral

MCFD Referral – Fill in MCFD worker’s info

Select Program Choices (up to 3 max)

Quick Links

Contact info

Referrals

Contact Info

Type of Referral

MCFD Referral – Fill in MCFD worker’s info

Select Program Choices (up to 3 max)

Quick Links

Social Media

Contact info