form test - Young Caregivers Association®

Contact & Referral Form

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What can we help you with?(Required)

Choose one option to continue.

Refer My Family or Myself For parents, guardians, and young caregivers (16+) seeking support.

Refer My Client or Patient For healthcare providers, school staff, and community agencies.

Volunteer & Student Opportunities Learn more about ways to get involved with YCA through volunteering, student placements and practicums.

Presentations, Training & Partnerships Book a meeting to learn how we can support you!

Feedback & Complaints Share confidential feedback or a concern directly with leadership.

Research Opportunities Collaborate on studies and research that advance support for young caregivers.

Refer My Family or Myself

Young caregivers are children and youth who help care for a family member. You do not need a diagnosis, a professional referral, or any paperwork to get started.

Who is this referral for?(Required)

Family Referral - for parents or guardians To learn more about programs and services for your child and youth.

Self Referral (16+) - for young caregivers age 16+ To learn more about program and services for yourself.

Refer My Client or Patient

Thank you for thinking of Young Caregivers Association for a family you are working with. Choose the submission option that works best for you.

How would you like to make the referral?(Required)

Complete Online Form Fill out the form on this page to send details directly to our Family Navigator.

Download & Send Referral Form (PDF) Download, complete offline, and send back to us.

Contact Family Navigator Directly Email us directly if you prefer to discuss the situation first.

Book a meeting to learn how we can support you!

This inquiry will go directly to Chrissy SadowskiCommunity Outreach

Organization Name(Required)

Contact Name(Required)

Email(Required)

Phone(Required)

Interests

Presentation

Training

Partnership

Other

Please specify(Required)

Please tell us a little more about what you are interested in or looking for.

Feedback & Complaints

Young Caregivers Association values feedback and is committed to addressing concerns or complaints in a respectful and timely manner. To share feedback, raise a concern, or submit a complaint, please contact:

Cayleigh Sexton
Executive Director
Email: cayleighs@youngcaregivers.ca

Volunteer & Student Opportunities

Volunteer Opportunities

Interested in making a difference in the lives of Young Caregivers? We are always looking for committed and passionate individuals to volunteer within our programs.

Becoming a Board Member
Assisting in Social Recreational Programs
Volunteer Driving
And More

If you are interested in volunteering with the Young Caregivers Association, we invite you to reach out by email to Alicia Pinelli, Director of Programs and Services at aliciap@youngcaregivers.ca.

Student Placements

At Young Caregivers Association, we are proud to support students through meaningful placement and practicum opportunities.

Please include:

Your Name
School Name
Program Name
Practicum Length
Attached Resume

If you are interested in applying for a student placement or practicum, please email Alicia Pinelli, Director of Programs and Services at aliciap@youngcaregivers.ca with the information above.

Research Opportunities

Young Caregivers Association welcomes opportunities to collaborate on research that advances understanding of young caregivers and strengthens supports for children, youth, and families.

To connect with YCA about a potential research opportunity or collaboration, please contact:

Cayleigh Sexton
Executive Director
Email: cayleighs@youngcaregivers.ca

How would you like to send the referral?(Required)

Complete Online Form Fill out the form on this page to send details directly to our Family Navigator.

Download & Send Referral Form (PDF) Download, complete offline, and send back to us.

Contact Family Navigator Directly Email us directly if you prefer to discuss the situation first.

Consent & Confidentiality

Consent and confidentiality

All referral information is treated as confidential and used to review and respond to this referral, subject to any disclosure required by law or an immediate safety concern.

About You (Referrer)

Referral Partner Name(Required)

Organization(Required)

Position

Phone Number

Email Address(Required)

Location

City/Town

About the Family

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

About the Young Caregiver

Young Caregiver(s) Name

Young Caregiver(s) Age

Referral Questions

What is the reason for your referral?

Would you like us to reach out to the family directly, or connect with you first for more information?

Reach out to the family directly

Connect with me first for more information

Is there anything else that would be helpful for our team to know?

Consent to exchange information(Required)

I / WE THE UNDERSIGNED AGREE TO THE EXCHANGE OF PERSONAL HEALTH INFORMATION REQUIRED TO REVIEW AND RESPOND TO THIS REFERRAL.

Upload a completed professional referral PDF

Download Referral Form 2025 (PDF)

Complete the PDF, then upload it below. The uploaded copy is attached to the staff email and purged from WordPress immediately after submission.

Your email address for a confirmation receipt(Required)

Upload the completed referral PDF(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

PDF only. Maximum file size: 10 MB.

Contact the Family Navigator directly

Email the Family Navigator directly at familynavigator@youngcaregivers.ca.

No information is submitted through this website when you choose this option.

Family Referral

Use this form if you are a parent, guardian, or family member referring one or more children for support.

Parent Name(Required)

Parent Email(Required)

Parent Phone(Required)

Location(Required)

Please specify location(Required)

Name of Child(ren) You Are Referring(Required)

Age of Child(ren) You Are Referring(Required)

Please share about your family and the support you are looking for below.(Required)

Confidentiality

The information you share with us is confidential and will be treated with the upmost care. Our team will only use this information to respond to your referral, and would only need to share information if we are required to by law or if there is a serious and immediate concern for someone’s safety.

Self Referral (16+)

If you are 16 or older and you help look after someone in your family, you can contact us directly using this form.

Your Name(Required)

Your Age(Required)

Please enter a number greater than or equal to 16.

Your Email(Required)

Phone

Location

Please specify location(Required)

Please share about your family and the support you are looking for below.

Confidentiality

Upload a completed family/self referral PDF

Download Referral Form 2025 (PDF)

Complete the PDF, then upload it below. The uploaded copy is attached to the staff email and purged from WordPress immediately after submission.

Your email address for a confirmation receipt(Required)

Upload the completed referral PDF(Required)

Drop files here or

Accepted file types: pdf, Max. file size: 10 MB, Max. files: 1.

PDF only. Maximum file size: 10 MB.

Confidentiality

Contact the Family Navigator directly

You can contact the Family Navigator directly at familynavigator@youngcaregivers.ca.

No information is submitted through this website when you choose this option.

Contact & Referral Form

Refer My Family or Myself

Refer My Client or Patient

Book a meeting to learn how we can support you!

Feedback & Complaints

Volunteer & Student Opportunities

Volunteer Opportunities

Student Placements

Research Opportunities

Consent & Confidentiality

About You (Referrer)

About the Family

About the Young Caregiver

Referral Questions

Upload a completed professional referral PDF

Contact the Family Navigator directly

Family Referral

Self Referral (16+)

Upload a completed family/self referral PDF

Contact the Family Navigator directly

About Us

Programs and Services

Resources