CURRENT REGION: Regina 306-347-5020

Referral Forms

ECIP has an open referral policy which means that anyone involved in the care of the child can refer to our program. If you're not yet sure if you should refer a child to our program, learn about us here or read more about our Core Services.

The information on this online referral form goes directly to our main email address, please provide the information you feel comfortable sharing with our program. We will be contacting you in the near future to discuss your child's needs further.

If you prefer to print off and mail or scan the referral directly to our program, scroll down to the bottom of the page to download our forms.

Online Referral Form

Child's Information
Caregiver 1 Information
Caregiver 2 Information
ECIP Support
Organization Information

Printable Form

Click the button below to download a printable (PDF) version of the form:

Referral Form


ECIP organizations share the vision that “All families have the capacity to meet the developmental needs of their children within the community of their choice.”

About ECIP


  • Enhance childhood development.
  • Identify family needs and strengths.
  • Support and empower families.
  • Provide links to community services.

Core Services


ECIP is a nonprofit organization funded through the Saskatchewan Ministry of Education, Health Canada and through donations and grants.

Sponsor Us