Refer

1300 946 337

Do you know someone who would benefit from one of our life-changing programs?

If you would like to refer someone to Windermere for a service (with their prior consent) please fill in the following form below. If you wish to enquire about a program for yourself, please visit the applicable service page.

Fields marked with an asterisk are compulsory.

Referrer Details

First Name *

Last Name

Email * eg. [email protected]

Phone eg. 04xxxxxxxx or 03xxxxxxxx

Company / Group

Postcode *

Do you have the person's permission to refer?

Yes
No

Referee Details

First Name *

Last Name

Is it advisable to contact the referee directly? *

Yes
No

If no, please provide details on the best way to make contact. Please enter preferred contact details

Please provide a brief message below

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48 Webb Street
Narre Warren, VIC 3805

ABN: 63 066 828 936

Registered Charity Number: A0025460D
Donations greater than $2 are tax deductible for Australian tax payers.

Windermere is committed to protecting the safety and wellbeing of all children and young people.

Phone: 1300 946 337
Fax: (03) 9796 7650
Email: [email protected]

Do you know someone who would benefit from one of our life-changing programs?

Referrer Details

Referee Details

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