Apply for a Stay

Cholmondeley accepts two types of referrals when applying for a child's stay: agency referral, or self-referral. 

Agency Referral

Those referring a child to Cholmondeley who are from:

  • a professional organisation or agency
  • a school
  • an NGO
  • Oranga Tamariki

need to contact us at or 03 329 9832 to request a special referral form. Once completed this form is needs to be scanned and emailed to


Admissions Form ImageIf you are: 

  • a parent/carer
  • family/whānau

of the child/ren being referred, you may begin the referral process by downloading the self-referral form. You must print and complete the form by hand, before signing, and returning to us via one of the following methods:

email |
post | PO Box 12276, Beckenham, Christchurch 8242

We can also post this form to you if you don't have access to a printer: call 03 329 98 32 to request one.

Please note: A separate form must be complete for each child from one family. Please tell us as much as much about the child's situation as possible. All information you provide will be kept secure and only used for the purpose of assessing the referral and planning for children's wellbeing during their stay.

If you need assistance with this form, or would like more information, please contact us — it's our job to help you where we can.