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Thrive Teen Parent Support Trust Referral Form

Please note: Thrive delivers services to teen parents to be and teen parents aged between 15-19 years. If the client is over this age or under this age, Thrive cannot guarantee services to the client/s identified. Thrive will accept referrals for either a teen mum or teen dad.

Thrive is able to inform you of other services if the client does not meet our entry requirements.

Name of Client being Referred



Date of Birth*

Current living situation*


What is the client's ethnicity?*
NZ EuropeanNZ MaoriSamoanNiueanChineseIndianOther, please state below or type N/A:

Is this a self referral?*

If no, please answer the following questions. Your Name, Address, Contact Phone, Email and Relationship to Client*

Client is aware of referral and has agreed to the referral being made*

Any worker safety alerts (risks), if so please explain:*

Reason for referral


Contact By Email

Contact By Phone

09 551 4367

Come To See Us

34 Lincoln Road, Henderson
Auckland 1025