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Youth Outreach Contact Form
Bridget Revell
2024-05-27T15:34:48-03:00
Connect With Youth Outreach Form
Please complete this form to set up Youth Outreach and we will get back to you in a few days
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This field is for validation purposes and should be left unchanged.
This is not an emergency service. If you have an emergency please call 911 or the Kids Help Phone at 1-800-668-6868
Youth Outreach is available for all youth 16-26. Youth Outreach is also available for youth 12-16 who are in the care of the Minister of Opportunities and Social Development.
Family Service Nova Scotia offers Youth Outreach in Cape Breton Regional Municipality, Inverness, Richmond, Antigonish, Guysborough Counties as well as Yarmouth and the Tri-County Region (Yarmouth, Digby, Shelburne Counties)
I am filling this form out for:
(Required)
Myself
Someone else
Name of Person completing form if different from youth
Phone Number for Person completing form
Relationship to Youth
Youth Name
(Required)
Pronouns
Date of Birth
(Required)
MM slash DD slash YYYY
Community you live in?
(Required)
How would you like us to reach out to you?
(Required)
Phone call
Text
Email
Other
Phone Number for Call or Text
Can a Voicemail be left?
Yes
No
E-mail
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