Foundry Sea to Sky Youth Outreach Referral Form

Foundry Sea to Sky Youth Outreach Program supports youth aged 12–24 living in the Sea to Sky Region. We accept referrals from teachers, professionals, community members, families, and youth themselves.

Our Youth Outreach Program provides a safe, welcoming space where youth can build trust, access support, and connect with local resources. A Youth Outreach Worker offers one-on-one guidance in key areas related to the Social Determinants of Health, including healthy living, financial literacy, housing, life skills, mental health, substance use, recreation, education, employment, and relationships. Through this support, youth are empowered to overcome barriers and thrive within their community.

Please note: Depending on the community where youth live, there may be a waitlist to access services. We’ll do our best to keep you informed and support youth while they wait.

For other services (Primary Care, Peer Support, Counselling and/or Youth Hub), please contact our admin team at 604-567-9347 or foundry@sscs.ca.

Youth Outreach Program Referral Form

Youth Self Referral (I am a youth 12-24 looking for support)
Community Referral (includes professionals, community members, family members, etc.)
Foundry Sea to Sky Inter-team Referral (ONLY for staff working at Foundry S2S)

Community Referral (includes professionals, community members, family members, etc.)

Foundry Sea to Sky Inter-team Referral (ONLY for staff working at Foundry S2S)

Youth Self Referral

Yes
No
Not Sure

E.g. Medical Appointments, Counselling, Peer Support, Outreach Program. This does NOT include Youth Hub.

Yes
No
Not Sure

Youth Information

Squamish
Whistler
Pemberton
Mt. Currie
Britannia Beach
D'Arcy
Other

Squamish
Whistler
Pemberton
Mt. Currie
Britannia Beach
D'Arcy
Other

	Name	Phone Number	Okay to contact this adult?
1	Name	Phone Number	Okay to contact this adult?
2	Name	Phone Number	Okay to contact this adult?
3	Name	Phone Number	Okay to contact this adult?

Referring Person’s Information (if applicable)

Referring Person’s Information

Reason for referral

School
Employment
Finances
Housing
Relationships (parents, friends, work, romantic)
Healthy Lifestyle
Life Skills
Mental Health Support
Substance Use Support
Community Connection (groups, programs, cultural connections)
Navigating services

Primary Care: Physical Health
Sexual Health: STI testing
Mental Health Support & Counselling
Substance Use Support & Counselling
Youth and Family Peer Support
Free Groups and Activities
Peer Support
Cultural Support
Outreach Worker
Employment Information and Support
Housing Support
Independent Living
Not sure, would like to explore options.
Other

	Name	Phone Number	Okay to contact?
1	Name	Phone Number	Okay to contact?
2	Name	Phone Number	Okay to contact?
3	Name	Phone Number	Okay to contact?

	Name	Phone Number	Okay to contact?
1	Name	Phone Number	Okay to contact?
2	Name	Phone Number	Okay to contact?
3	Name	Phone Number	Okay to contact?

please explain

For example, safety plans, situations that feel stressful, behaviors when feeling upset, or concerns about others’ actions toward you.

Availability

Client's medical background

Risk assessment

Consents

By checking this box, you are confirming the youth is aware and consenting to this referral being submitted to Sea to Sky Community Services.

By checking this box, you are confirming that the youth is aware of the Youth Outreach Program Role.