Group & Holiday Activities Expressions of Interest

Group & Holiday Activities Expressions of Interest

Filling in this form does not guarantee a spot in the group. It is an enquiry only.
Participant Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

TownState

Post Code
Email*
example@example.com
Mobile Number*
Weekly groups - Please select the group you are interested in
Holiday Activities - Please select the activity you are interested in
What level of support does your child require to successful participate in selected activities*
Additional information staff should be aware of. E.g. Risks, Allergies, sensory preferences, any modifications that can be made to make your child feel comfortable and welcome.
Does your child have a current NDIS plan? (Groups are charged weekly to the NDIS plan)*

YESNO
Cost:

All groups will be billed under the Capacity Building - Improved Daily Living funding stream.
Should be Empty: