Client Referral | Rowell Family Empowerment
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Client Referral

Referral Disclosure Agreement

By submitting a client referral through this website, you agree that Rowell Family Empowerment is authorized to use the information presented for the sole purpose of referral to services provided by programs within the agency that will address the needs described regarding the child and family you refer.

Every effort will be made to keep the information you provide confidential. This consent pertains only to information collected through this website.


Family/Parent Information

NOTE: If no email type NoEmail@No.com

Unfortunately, we are only funded to provide services to families who reside in Butte, Glenn, Shasta, Siskiyou, Tehama and Trinity counties. If you live in a different county please call Warmline Family Resource Center at 1-800-455-9517.

However, if you have a baby who is deaf or hard of hearing (please mark the check box above) we can serve you throughout counties in central and northern California!

Child Information

Referrer Information

Include reason for referral and ask questions here.

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