{"id":187,"date":"2023-01-30T13:09:54","date_gmt":"2023-01-30T02:39:54","guid":{"rendered":"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/?page_id=187"},"modified":"2023-03-02T17:18:13","modified_gmt":"2023-03-02T06:48:13","slug":"187-2","status":"publish","type":"page","link":"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/187-2\/","title":{"rendered":"Nazareth Family Support Referral Form"},"content":{"rendered":"<script>\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: false,\n\t\tscriptsLoaded: false,\n\t\tthemeScriptsLoaded: false,\n\t\tisFormEditor: () => typeof InitializeEditor === 'function',\n\n\t\t\/**\n\t\t * @deprecated 2.9 the use of initializeOnLoaded in the form editor context is deprecated.\n\t\t * @remove-in 3.1 this function will not check for gform.isFormEditor().\n\t\t *\/\n\t\tcallIfLoaded: function ( fn ) {\n\t\t\tif ( gform.domLoaded && gform.scriptsLoaded && ( gform.themeScriptsLoaded || gform.isFormEditor() ) ) {\n\t\t\t\tif ( gform.isFormEditor() ) {\n\t\t\t\t\tconsole.warn( 'The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.' );\n\t\t\t\t}\n\t\t\t\tfn();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\treturn false;\n\t\t},\n\n\t\t\/**\n\t\t * Call a function when all scripts are loaded\n\t\t *\n\t\t * @param function fn the callback function to call when all scripts are loaded\n\t\t *\n\t\t * @returns void\n\t\t *\/\n\t\tinitializeOnLoaded: function( fn ) {\n\t\t\tif ( ! gform.callIfLoaded( fn ) ) {\n\t\t\t\tdocument.addEventListener( 'gform_main_scripts_loaded', () => { gform.scriptsLoaded = true; 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For urgent school related matters, please contact the College on 8406 5300.  For crisis support or urgent medical assistance, please call 000 or present at your local hospital.<\/div><\/li><li id=\"field_19_75\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Who is Referring<\/h2><\/li><li id=\"field_19_64\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_64'>Select<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_19_64' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Parent\/Caregiver' >Parent\/Caregiver<\/option><option value='Nazareth Student' >Nazareth Student<\/option><option value='Staff member' >Staff member<\/option><\/select><\/div><\/li><li id=\"field_19_134\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_134'>Role at Nazareth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_134' id='input_19_134' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_76\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Your details<\/h2><\/li><li id=\"field_19_65\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_65'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_65' id='input_19_65' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_72\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_72'>Last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_72' id='input_19_72' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_68\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_68'>Contact number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_68' id='input_19_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_39\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_39_container'>\n                                <span id='input_19_39_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input autocomplete=\"off\"  class='' type='email' name='input_39' id='input_19_39' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_39' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_39_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input autocomplete=\"off\"  class='' type='email' name='input_39_2' id='input_19_39_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_39_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_19_130\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Referral<\/h2><\/li><li id=\"field_19_118\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_118'>I would like support provided for a Nazareth family.  I.e. student currently enrolled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_19_118' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_19_129\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_129'>I would like to be contacted about possibly providing support (in the form of meals) to a current\/past staff member, past student\/family or other member of the Nazareth community<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_19_129' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_19_128\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_128'>Please tell us the reason for support?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_128' id='input_19_128' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_74\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_74'>Have parents\/caregivers been made aware of this referral?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_19_74' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_19_92\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Student Details<\/h2><div class='gsection_description' id='gfield_description_19_92'>If there are multiple students at Nazareth, please only provide us with the details of one student.<\/div><\/li><li id=\"field_19_93\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_93'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_93' id='input_19_93' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_94\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_94'>Last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_94' id='input_19_94' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_97\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_97'>Year level<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_19_97' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Reception' >Reception<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><\/li><li id=\"field_19_77\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Reason for Referral<\/h2><\/li><li id=\"field_19_109\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Family Support may be required at different times for students and families of the Nazareth community, and supports offered to families are available in the following areas.  Please indicate which of the following areas are relevant.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_109'><li class='gchoice gchoice_19_109_1'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.1' type='checkbox'  value='Access and support with school supplies (eg uniform, stationery)'  id='choice_19_109_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_1' id='label_19_109_1' class='gform-field-label gform-field-label--type-inline'>Access and support with school supplies (eg uniform, stationery)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_2'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.2' type='checkbox'  value='Information and referrals to external supports (eg Foodbank)'  id='choice_19_109_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_2' id='label_19_109_2' class='gform-field-label gform-field-label--type-inline'>Information and referrals to external supports (eg Foodbank)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_3'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.3' type='checkbox'  value='Family Support (eg health, accommodation\/housing, change in family dynamics)'  id='choice_19_109_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_3' id='label_19_109_3' class='gform-field-label gform-field-label--type-inline'>Family Support (eg health, accommodation\/housing, change in family dynamics)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_4'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.4' type='checkbox'  value='Exploring potential financial supports (eg school card)'  id='choice_19_109_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_4' id='label_19_109_4' class='gform-field-label gform-field-label--type-inline'>Exploring potential financial supports (eg school card)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_5'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.5' type='checkbox'  value='Family bereavement\/grief'  id='choice_19_109_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_5' id='label_19_109_5' class='gform-field-label gform-field-label--type-inline'>Family bereavement\/grief<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_6'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.6' type='checkbox'  value='Advocacy'  id='choice_19_109_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_6' id='label_19_109_6' class='gform-field-label gform-field-label--type-inline'>Advocacy<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_109_7'>\n\t\t\t\t\t\t\t\t<input autocomplete=\"off\"  class='gfield-choice-input' name='input_109.7' type='checkbox'  value='Other'  id='choice_19_109_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_109_7' id='label_19_109_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_110\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_110'>Other<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_110' id='input_19_110' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_133\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_133'>Have you spoken to your family about this referral?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_133' id='input_19_133' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_19_79\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Background Information<\/h2><\/li><li id=\"field_19_80\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_80'>Please provide any  background information that may help us best assist the family.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_80' id='input_19_80' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_113\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_113'>Please provide us with any relevant information about your current situation so we can best assist you and\/or your family.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_113' id='input_19_113' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_124\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_124'>Is there anything else you would like to share about your family that would help us to provide the best support. Ie, does your family recieve support from anyone else?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_124' id='input_19_124' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_81\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Additional Support<\/h2><\/li><li id=\"field_19_86\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_86'>Are there any current external services providing support? I.e. Centrecare, Housing SA, NDIS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_19_86' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><option value='Unknown' >Unknown<\/option><\/select><\/div><\/li><li id=\"field_19_87\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_87'>Please provide additional information if known<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_87' id='input_19_87' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_121\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_121'>In addition to Family Support, the Nazareth Counselling Team is available to support our students. Would you like to make a referral to the Nazareth Counselling Team?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_121' id='input_19_121' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_19_112\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Nazareth Counselling Team<\/h2><div class='gsection_description' id='gfield_description_19_112'>Please complete this form to be contacted by a member of the Nazareth Counselling Team. <a href=\"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/184-2\/\" target=\"new\" style=\"color:red; font-weight: bold;\">Click here (opens new tab)<\/a>.  <\/div><\/li><li id=\"field_19_120\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Family and Pastoral Care Coordinator Contact<\/h2><\/li><li id=\"field_19_123\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_123'>If there is a preferred day\/time for the Family and Pastoral Care Coordinator to make contact to discuss this referral, please provide details.<\/label><div class='ginput_container ginput_container_select'><select name='input_123' id='input_19_123' class='large gfield_select'     aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes, provide details' >Yes, provide details<\/option><option value='No, any time' >No, any time<\/option><\/select><\/div><\/li><li id=\"field_19_116\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_116'>The best time to contact is:<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_116' id='input_19_116' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_131\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_131'>Is there a preferred time to contact your family to discuss the referral?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_131' id='input_19_131' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Please select' selected='selected'>Please select<\/option><option value='Yes, provide details' >Yes, provide details<\/option><option value='No, any time' >No, any time<\/option><\/select><\/div><\/li><li id=\"field_19_132\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_132'>The best time to contact my family is:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_132' id='input_19_132' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_73\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Confidentiality<\/h2><div class='gsection_description' id='gfield_description_19_73'>Maintaining privacy and confidentiality standards are of the utmost importance to our counselling team.  For further information on our confidentiality requirements.\n\n<a href=\"https:\/\/www.nazareth.org.au\/__files\/d\/153454\/Confidentiality.pdf\" target=\"new\" style=\"color:red; font-weight: bold;\">Click here \n (opens new tab).<\/a><\/div><\/li><li id=\"field_19_35\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full consent-form-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Acknowledgement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input autocomplete=\"off\"  name='input_35.1' id='input_19_35_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_19_35\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_19_35_1' ><\/label><input autocomplete=\"off\"  type='hidden' name='input_35.2' value='' class='gform_hidden' \/><input autocomplete=\"off\"  type='hidden' name='input_35.3' value='27' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_19_35' tabindex='0'>I acknowledge that the information I have provided in this form will be received by the Nazareth Family and Pastoral Care Coordinator, and may be shared with relevant staff members at their discretion.  While all information provided within referrals is treated in a respectful and sensitive manner, the sharing of information may at times be necessary in order to meet our duty of care.  For further information please <a href=\"https:\/\/www.nazareth.org.au\/__files\/d\/153454\/Confidentiality.pdf\" target=\"new\" style=\"color:red; font-weight: bold;\">click here (opens new tab)<\/a>.  The Family and Pastoral Care Coordinator will strive to respond to your referral as soon as possible.  Please note that referrals may not be received until the following working day and will not be monitored over weekends and school holiday periods.  For urgent school related matters, please contact the College on 8406 5300. 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