QPS Registrations Form

This is the referral form for the QPS Police Kids Trial Program.

If you have any questions regarding this form, you can contact:

Olivija Harvey – Manager, Police Kids Program – olivija.harvey@kookaburrakids.org.au

Jessica Cluney – Head of Clinical Services – clinical.services@kookaburrakids.org.au

Eligibility Criteria*

This is the online referral form to the Kookaburra Kids Police Kids program.

Please take your time to read our referral criteria, and complete the following details to the best of your knowledge. Should you require any assistance when completing this form, please phone your local Kookaburra Kids office on 1300 566 525.


  • Referred child must be aged between 8 to 18 years or in Grades 3 to 12.
  • Referred child must have a parent/caregiver or sibling with a mental illness.
  • Children referred from QPS families must have a serving/ex-serving parent with a mental illness.
  • We do not provide specialist mental health intervention, ongoing support, and/or intensive supervision. We are therefore unable to support children with severe and complex needs.
  • Kookaburra Kids may contact the referrer and parent/caregiver for further information.
  • A child’s acceptance into the program will be confirmed directly with the parent/caregiver.
  • Invitations to camp and accompanying activities days will be emailed directly to the family when these events are offered in their local area.
  • Information supplied on this form will be managed sensitively and confidentially.
  • The young person must be eligible for camp in order to attend an activity day. Children cannot be referred directly to, or only to an activity day.
Children can be referred by:
  • School Counsellors
  • Mental health workers
  • GP’s
  • Family members
  • Community workers
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