Kites and VisAbility Term 2 Therapy Groups Enrolment Form

Kites & VisAbility Term 2 Therapy Group Programs

Enrolment Form - we are continuing to accept enrolments.
Kites, VisAbility and Children's Therapy Centre are pleased to bring to you a comprehensive range of exciting, therapy-based groups during Term 2. Our groups are a great way for kids to learn and practise skills with other children with other children under the guidance of our skilled Therapists. Groups will run weekly from the week of 04 May, 2020 (Second Week of School Term) and are 45 minutes in duration. It's still not too late to sign up!
Today's Date

DayMonthYear
Date
Child's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Enter date in format dd/mm/yyyy.
Age
Phone Number*

Area CodePhone Number
Do we have your address and other important contact details on our system at VisAbility, Kites or Children's Therapy Centre?

YesNo (please call us)
What funding will cover your child's attendance?

NDIS (current Services Agreement is in place for therapy)NDIS (require a Service Agreement)Pay fee for serviceUnsure (please call us to discuss your situation)

Primary Emergency Contact Name*

First NameLast Name
Primary Emergency Contact Relationship to Child*
Please mark which groups you would like to enrol your child in
Speech Pathology groups ($71.13 per session)

Tiny Talkers (1 - 4 year olds, starting Tuesday 05 May, 9am WST and 11am EST). For children with communication goals, focusing on expanding vocabulary, book-sharing, and play skills such as turn-taking. Facilitated by a Speech PathologistSocial Thinkers (9 - 12 year olds, starting Thursday 07 May, 3:30pm WST and 5:30pm EST). Develop conversation skills and social awareness strategies to develop self-regulation and friendships. Suitable for children who have goals around social skills, self-regulation and resilience.
Occupational Therapy groups ($71.13 per session)

Scribbles to Circles (2-5 year olds, starting Thursday 07 May, 9am WST and 11am EST). Practise pre-writing skills such as drawing, copying and pencil control. Suitable for children with fine motor and handwriting skills. Facilitated by an Occupational Therapist)Hands On Handwriting Group (6 - 11 year olds, starting Thursday 07 May, 2:30pm WST and 4:30pm EST). An interactive group that focuses on developing letter formation, speed and legibility. Suitable for children with handwriting goals. Facilitated by an Occupational Therapist)
Physiotherapy groups ($82.36 per session)

Training Team (4 - 6 year olds, starting Monday 04 May, 9am WST and 11am EST) practise strength and balance -based goals through games, with other kids. Facilitated by a Physiotherapist.Workout Worriors (7 - 10 year olds, starting Monday 04 May, 2:30pm WST and 4:30pm EST) practise strength and balance through games, with other kids. Suitable for students with strength or balance goals. Facilitated by a Physiotherapist.

Terms of Participation and Agreement

Please read the following terms carefully before signing this form.
- I understand that I am required to supervise my child during group programs.
- I understand that for consistency, it is recommended to attend all sessions.
- Enrolling my child into a group (unless stated otherwise) will assume that your child will attend all sessions.
- Cancellations for each session will be charged at 100% if cancelled within 48 business hours.
- I have suitable technology for my child and to engage in video-based sessions.
- I understand that minimum numbers must be met, otherwise specific group sessions will be cancelled.
- Everyday household and craft items may be required for some sessions.
Acknowledgement of terms and conditions*

I have read and understood the terms and conditions
Confirmation

By signing this enrolment form, I agree to the terms of participation in the above-mentioned program/s.
Name of Parent/Legal Guardian*

First NameLast Name
Signature of Parent / Legal Guardian
Date signed*

DayMonthYear
Enter date in format dd/mm/yyyy.
To receive an electronic copy of your completed form please enter your email address:
example@example.com
Should be Empty:

Kites & VisAbility Term 2 Therapy Group Programs

Please mark which groups you would like to enrol your child in

Terms of Participation and Agreement

Confirmation