EXPRESSION OF INTEREST FOR DAY PROGRAM AT WE ROCK THE SPECTRUM SYDNEY WEST
Participant Name
First Name
Last Name
Parent/Carer's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Participant Date of birth
-
Month
-
Day
Year
Date
Please tick the level of support your child needs
One staff member to one child ratio (1:1 Support)
One staff member to 3 children (1:3 support)
Please tick how many days your child will be attending
1 Day
2 Days
3 Days
4 days
5 Days
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Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
-
Month
-
Day
Year
Date
Has your child attended WRTS Group sessions
YES
NO (if no we will arrange an induction session)
Do you have more than 1 child attending program
YES
NO
Childs Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
MEDIA CONSENT We occasionally post photos from the day on our Instagram and Facebook page to show the daily activities. No names are listed. Are you ok for your child’s image to be posted?*YESNO
YES
NO
DIETARY REQUIREMENTS & ALLERGIES Some activities have a food element to them. Does your child have any allergies/intolerances? If so, please provide details.
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Signature
Continue
Continue
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