Workshop Registration Form

Workshop Registration Form
Select a Workshop Option
Which Workshop program are you looking to register for?

Let's Get Social - SparksBack In the KitchenLet's Get SocialIn the KitchenLet's Get Social - LadiesKeeping Active and WellOn the RoadAround The HouseIn the Kitchen - ThermomixLet's Get Away
How did you hear about our Workshops

1. First, Let's Get to Know You!
Name

First NameMiddle NameLast Name
Gender

MaleFemalePrefer not to Identify
Date of Birth

DayMonthYear
Date
Age
Email Address
example@example.com
Any additional comments or information you would like to share?

2. Next, Tell Us About Your NDIS arrangements
What Type of NDIS Plan do you have?

Self-ManagedPlan-ManagedI don't have a plan
NDIS Number
What's your plan number
NDIS Plan Date from:

DayMonthYear
Date
NDIS Plan Date to:

DayMonthYear
Date

3. Now, Give Us Your Other Contact Details
Address

Street Address

Street Address Line 2

CityState

Post Code (eg 6234)
Mobile Number

4.Ok! Tell Us a Bit About Yourself
What are your support requirements?
Do you have any known allergies or food intolerances?
Do you have any special or cultural dietary requirements?
Do you have any food preferences or specific dislikes?
Please outline any other support requirements that we should be aware of to ensure the safety and success of your participation. If none, please simply respond with N/A:

5. Next we need another Contact (Parent/Guardian or Support) for you?
Name

First NameLast Name
Relationship
Phone Number
Email Address
example@example.com

6. Now, Please provide us some Payment and Invoicing Details
Person we should send an Invoice to?

First NameLast Name
Email Address
example@example.com
If applicable, what is the name of the organisation they are associated with? If none, please respond with N/A:
CANCELLATION TERMS:

Our workshops are often more than fully subscribed, and so we run a Cancellation Policy to encourage participation. The policy is as follows:
- Cancellation > 7 days before a start date - NO charge
- Cancellation < 7 days before a start date - 75% charge
- Cancellation < 1 day before start date - 100% charge
We always try and fill sessions from our waitlist; and where we are able to do this successfully - NO CHARGE will apply

7. We'd like your consent for a few things
Does the participant consent to Lightbulb Skills taking photographs & video footage during the workshop which may be used in the future, e.g - on our website?

YesNo
Does the participant consent to being part of closed Lightbulb Skills Social Media Groups?

YesNo

9. Some questions for Let's Get Social
Did you sign up for Let's Get Social

YesNo
What is your level of confidence in Social Settings

1

2

3

4

5

1 is I have very little, 5 is I am very confident
Tell us three of your interest or hobbies
Tell us three activities you would like to do with others in this Workshop

Finally, Some Legal Stuff we need to share
Our workshops are designed to increase the skill and level of independence that you or your participant experiences in the kitchen. Each workshop is delivered using explicit instruction in a fun and engaging manner within a social setting.

Our workshops are not designed to replace therapy, contradict health advice or learned skills that you or your participant have been taught in the past by healthcare professionals and therapists. We are facilitators delivering material that is practical and based upon the knowledge we have gained through our own lived experience.

Any and all nutritional information and materials delivered are used to understand basic nutrition in line with Australian Department of Health guidelines and are not intended as health advice.

Workshops require me to pay for my own meal travel unless these are identified as being included within the Workshop structure.

This record is owned by Lightbulb Skills and protected within the guidelines of our privacy policy. Information within this record will only be shared with other Lightbulb Skills team members and their associates on an as needed and agreed basis. And, at any time, I can ask to see this record and receive a copy

Lastly, to the best of my knowledge, the information provided in this form is true and correct.
What do you hope to achive from this Workshop?
Has someone helped or assisted you with this Registration?

YesNo
If Yes, please give us the name of who helped you?
Date

DayMonthYear
Date
Should be Empty: