Youth Mobilisation and Response Enquiry

Privacy Statement

Your personal, sensitive and health information is being collected by Council for the purposes of providing Support Services and meeting statutory obligations under the Children, Youth and Families Act 2005.

Your information will be stored in Council’s Customer Database and used to identify you when communicating with Council and for Council to deliver services and information to you. For further information on how your personal, sensitive and health information will be handled, please refer to the Council’s Privacy Policy at www.wyndham.vic.gov.au/privacy-policy

Youth Response and Mobilisation service offered by Wyndham City Council Youth Services is a free and voluntary service for people over 12 years old who live, work or recreate in Wyndham. (required) If you have answered ‘No’ to any of these questions, please contact the YRM at Youth Services on (03) 8734 1355 to discuss whether a referral should proceed, otherwise please continue filling out this online enquiry form. (required)

The person/family is aware of the referral

The person voluntarily wants support

member of the family is aged 12-25

The person has a connection to Wyndham

Please select: (required)

I am making a referral for myself

I am making a referral on behalf of someone else

I am requesting for support at a school

Emergency Contact information (This must be a responsible adult in the community member’s life over the age of 18)

Name

Relationship to you (e.g. mother/father)

Phone number:

Are they aware of this referral?

Post Incident School Support

Availabilities (required)

Please tick the methods of support you are willing to receive:

Video call session

Phone Call

On-site session

Full name

Position Title:

School name:

Phone Number:

Email Address

Please tell us about the incident that has affected the school community:

Please tell us what support you may require: (please note that we may not be able to meet all requests but can refer to organisations that can support)

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Acknowledgement of Traditional Custodians

Wyndham City Council recognises Aboriginal and Torres Strait Islander peoples as the first Peoples of Australia. We acknowledge the Bunurong and Wadawurrung Peoples as Traditional Owners of the lands on which Wyndham City operates. The Wadawurrung and Bunurong Peoples have and always will belong to the Werribee Yalook (river), creeks, stars, hills and red clay of this Country. We pay respect to their Ancestors and Elders who always have, and always will, care for Country and community today and for future generations.