Request Befriending

Request Befriending

I am requesting a Befriender for:

Myself

Someone else

Your name:

Email address:

Phone Number:

If not for yourself, what is the name of the person you're referring:

Referral's Phone:

Referral's Email:

What is your relationship to referral:

Does the referral consent to us contacting them?

Yes

No

Reason for referral:

Brief outline of present circumstances:

Please provide any other additional information about the person referred that might prove helpful in making a successful match with a befriender:

Date:

Thank you for applying for Befriending. We will get back to you as soon as possible.

Kind regards,

WWAC

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Tel: 07514 534978

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