Program Expression of Interest Form

Express your interest in our Term Programs

Please complete the form below to express interest in our online and clinic based programs
Child's First Name
Child's Last Name
child's Date of Birth

DayMonthYear
Date
parent/carer Full name
First Name
contact Email
example@example.com
contact Number
If we need to contact you regarding this booking
Existing Client?
Is the participant NDIS funded?
PLEASE NOTE: The Play Projects will need to complete a planning appointment prior to commencing any therapy or services to ensure that clients are matched to the appropriate team members/programs and that any risks or barriers that may impact the quality of your service can be addressed and planned for.

Express your interest in our Term Programs