Get Support

Register a Child

Please complete this form to refer a child to LACH. Submission of this form does not automatically guarantee enrolment or support. Our team will review the information provided and contact you regarding the next steps.

Child Information

Child's name *

Age

Date of birth

Gender

Location

School currently attending

Class / grade

Educational needs

Parent / Guardian Information

Parent / guardian name *

Relationship to child

Phone number *

Email *

Location

Preferred method of contact

Why are you referring this child?

Please briefly tell us about the child and the kind of support you believe they need. *

What type of support are you seeking?

Educational support School supplies Mentorship Child development support Psychosocial/family support Scholarship/financial assistance Other

If "Other", please specify

Consent & Safeguarding I confirm that I am the parent/guardian or authorized adult making this referral and consent to LACH collecting and using the information provided for the purpose of assessing the child's eligibility for LACH programmes. *