Make a Referral

    If Under 18 and not living independently, please provide details of Parent/Guardian.
    Reason for referral

    Please include any organisational Reference numbers:


    Acceptance of a place on one of our programmes does not and cannot be used to influence any current or future legal action being taken in respect of any offences that may be investigated, nor will any referral to the Chrysalis Centre preclude a prosecution from taking place.

    Referrer’s details