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Page 1

The Pyjama Foundation Referral Form

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The Pyjama Foundation Love of Learning Program™, is a literacy-based mentoring program creating positive, life-long change for children in care. The Pyjama Foundation recruits, screens, trains and supports volunteer Pyjama Angels who visit a child in foster care or kinship care once a week for at least an hour, to read books aloud, play educational games and help them with their homework.

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NSW Referral























VIC Referral























QLD Referral














I am referring as the Child's: Other


My Details









Child's Child Safety Officer Details








Carer Details







Please do not populate your own work email address. If Carer does not have a valid email, input Carer's Surname.
















Residential Carer Details



















Page 2

Details of Child being referred

Child Details








Reason for making this referral to The Pyjama Foundation

(Tick all that apply)
Yes No









We request that where appropriate you've discussed the referral with the child.


To the best of your knowledge, please rate the child's skills and abilities on a scale of 1 - 5.  1 being Very poor and being 5 Excellent

1 2 3 4 5

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Agreement and Consent

  1. I agree that the information provided is correct. If the child's or carer's circumstances change, I will notify The Pyjama Foundation immediately.

  2. I give permission for the child to participate in educational activities offered by The Pyjama Angel.

  3. I give The Pyjama Foundation permission to use the child's personal information on a database for the purpose of record keeping and data collection.*

  4. I give The Pyjama Foundation permission to regularly ask for feedback from the child and their carer about the service provided, and to use this information to monitor and improve the Love of Learning Program.

  5. I understand that The Love of Learning Program is for a minimum of 3 months. The program may continue for a longer duration if required.

  6. I understand that I can withdraw this referral at any time by contacting The Pyjama Foundation.

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