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Make a Referral

If you’d like to find out more about how Wombat’s Wish can help a child or young person that you know, you can fill out a referral form here. You can make a referral for your own child/young person, or one that you professionally support. Our friendly and caring team will be in touch to share more information and help with the next steps.

Family Details

Childs Details

Child 1

Gender *

Child 2

Gender

Extra Children Details

Child 3

Gender

Child 4

Gender

Deceased Person Details

Referral Details

Is this a self-referral? *
Referral for following Programs

Further Information