Referral Form

Whānau Consent - Awareness

Has the whānau been informed about this referral?

Please tick any areas that may be relevant to this referral

(This helps us understand whānau circumstances -  it does not mean Kupega Moana provides all these services directly.)

Our current programmes include

• Fale Māfāna – Home-visiting service supporting mothers’ emotional wellbeing and aiga during the early stages of their child’s life.

• Pasifika Shining Lights – Primary mental health support for Pasifika parents and children aged 0–5 experiencing mild to moderate mental health or addiction issues.

• Childbirth Education & Support Services (Anofale) – Antenatal and postnatal care offering culturally responsive childbirth education and transition-to-parenthood support.

• Roots Men’s Support – A safe, positive space for tāne to talanoa, connect through sport, and build wellbeing and leadership within their whānau.

• Pasifika Parenting Innovations Centre (PPIC) – Parenting courses that empower Pasifika parents to raise children confidently in Aotearoa.

• Pasifika Resilience – Long-term healing and recovery support for individuals and whānau impacted by violence, working to strengthen safety and break cycles of harm.

• Inati – A community-based initiative drawing on Tokelauan traditions of shared support and resourcefulness; connecting Pasifika whānau to community networks and services.

Child / Tamaiti information (for context only)

(Do not include child names as age and background information are sufficient for referral.)

Parent / Caregiver Information

Second Parent / Caregiver Information (if applicable)

Referrers details