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10
Questions
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1
Which group(s) are you’re interested in?
Hydrotherapy
Fitness
Walking
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2
Date of Birth
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Date
Year
Month
Day
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3
Diagnosis (if applicable)
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4
Funding (i.e NDIS, private etc)
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5
Physical abilities / limitations (
eg ability to mobilise, pain, transfers, deformity)
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6
Are there any specific / special needs to be able to attend?
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7
Why do you want to attend the group?
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8
Email
example@example.com
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9
Parent / Carer Name
First Name
Last Name
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10
Contact Phone Number
Area Code
Phone Number
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