Weekend Program Registration Form
Register for our upcoming Term 4 Weekend Programs!
19th October 2024 - 21st December 2024
Participant Details
Participant's Full Name:
*
First Name
Last Name
{participantsFull:first}'s Date of Birth
*
/
Day
/
Month
Year
Date
Is {participantsFull:first} currently registered with Sparkle Centre?
*
Yes
No
Have {participantsFull:first}'s details changed?
*
Yes
No
{participantsFull:first}'s NDIS Number:
Please enter Participant's NDIS number
{participantsFull:first}'s Address:
Street Address
Street Address Line 2
Suburb
State
Postcode
Emergency Contact 1 Details
Emergency Contact Name:
*
First Name
Last Name
Relationship to {participantsFull:first}:
*
Emergency Contact Number:
*
Emergency Contact Email Address:
*
Emergency Contact 2 Details
Emergency Contact Name:
First Name
Last Name
Relationship to {participantsFull:first}
Emergency Contact Number
Emergency Contact Email Address:
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Weekend Program Booking
Which Weekend Programs would you like to book in for?
*
Diwali Festival (19th October)
Halloween Mask Making (26th October)
Sculptures by the Sea (2nd November)
Australian Botanical Gardens (9th November)
Berry Island Walk (16th November)
Swimming Day (23rd November)
Visit to Parramatta Park (30th November)
Beach Day (7th December)
Wiggles Concert (14th December) LIMITED SPOTS AVAILABLE!
Christmas Crafts and Cooking (21st December)
Please list any dietary requirements and/or allergies:
Leave blank if not applicable
Is there anything else you would like to include?
Leave blank if not applicable
Does the {participantsFull:first} hold a current NSW Companion Card?
*
Yes
No
Participant’s Companion Card:
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Signature
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Full name of the person completing form:
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First Name
Last Name
Date
*
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Year
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