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If you would like to refer a young person to see the youth lawyer, please download and submit the following referral form or simply fill the form in online (scroll below).

Referral Form

I consent to being contacted to arrange an appointment with the youth lawyer at Ballarat Community Health.

Please note that all appointments will be subject to a conflict check.

Conflict of interest check

Youthlaw conducts a mandatory “conflict of interest” check. We cannot assist someone if a legal conflict of interest exists. For example if we have previously assisted the other party to your specific legal dispute we are unable to assist you. A legal conflict of interest occurs when the duties a lawyer owes to his or her client come into conflict with the duties a lawyer owes to the court, to a different client or with the lawyer's personal interests.

Youthlaw Ballarat Referral Form

Use to refer a young person with a legal problem to Youthlaw Ballarat.

The compulsory fields are denoted by an asterisk *

Worker's Details

Young Person's Details

(dd/mm/yyyy)

* Please provide at least one of the following contact methods (Phone, Email, or Address).

 Yes   No
(dd/mm/yyyy)

Other Party/Parties' Details

Person/s or organisation/s the young person is in conflict with.

This information is needed to conduct a conflict check. If Youthlaw has a conflict we will not be able to assist the young person. Instead, we will notify the worker and provide suggestions for other lawyers who may be able to assist.

(dd/mm/yyyy)

If there are more than 2 additional parties, please provide any additional party's in the textarea below.

(dd/mm/yyyy)

I agree that the information I have provided is current.