Little Wonderz September Holiday

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Follow us to get the latest news about our exciting adventuresjoin our Wonder Family

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Are you new to the Wonder Family?* This field is required.

YESNO

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Is your child 12 Yrs old or older?* This field is required.If YES, Please fill out the Tweenz Form

YESNO

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Child Name* This field is required.

First Name

Last Name

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Any Changes from the last holiday booking? * This field is required.ex: home address, medications, allergies, behaviours...

YESNO

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Kindly let us know the changes from the last holiday * This field is required.ex: home address, medications, allergies, behaviours...

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Primary Carer Name* This field is required.

First Name

Last Name

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Primary Carer Email* This field is required.

example@example.com

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Primary Carer Phone Number* This field is required.

Please enter a valid phone number.

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Date of Birth * This field is required.

Date

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Gender* This field is required.

Male

Female

Other

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Is the child considered* This field is required.

An Aboriginal

No

Torres Strait Islander

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Child Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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School* This field is required.

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Diagnosis* This field is required.

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Sensory Preferences (likes, enjoys and calm them down)* This field is required.

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Sensory Triggers (avoids, dislikes and triggers them)* This field is required.

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Self feeding* This field is required.

YESNO

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Self toileting* This field is required.

YESNO

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Is the child an NDIS participant?* This field is required.

YESNO

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NDIS Number* This field is required.

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The plan is* This field is required.

Self-managed

Plan Managed

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Billing Email* This field is required.

example@example.com

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Cultural Background* This field is required.

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Dietary Requirements* This field is required.

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Required Dates * This field is required.1 spot per child

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The Care ratio* This field is required.No Activity fees will be included

1:1 = 65.0 $/hr

1:2 = 40.0 $/hr

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By selecting YES, I am accepting to pay my child`s out-of-pocket activities fees prior to the school holidays commencing. These fees are not funded by the NDIS. * * This field is required.you will receive an invoice not related to NDIS

YESNO

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Any Behaviours of concerns?* This field is required.IF you choose (YES) , your child is required to be 1:1

YESNO

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Behaviours of concerns* This field is required.

Absconding

Self harm

Harming others

others:

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Any Positive Behaviour Support plan ?* This field is required.

YESNO

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Any allergies?* This field is required.* If yes, please not we need an medication action plan that is within 12 months of date signed by a medical practioner

YESNO

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Kindly upload it* This field is required.please not we need an medication action plan that is within 12 months of date signed by a medical practioner

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Allergy cause* This field is required.

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Allergy signs and symptoms* This field is required.ex: rashes, swelling, sweating..

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is there any anaphylaxis/allergy plan?* This field is required.please not we need an medication action plan that is within 12 months of date signed by a medical practioner

YESNO

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Kindly upload the plan* This field is required.please not we need an medication action plan that is within 12 months of date signed by a medical practioner

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Any medications?* This field is required.*If the child needs to be given medication during the session or in case of emergency

YESNO

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Medication Name* This field is required.AS Labelled

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Dosage given:* This field is required.

As prescribed by the doctor

As instructed on the packaging

As needed.

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By selecting YES, I am giving my consent for the staff at Wonder Kidz to administer medication to my child as outlined above.* This field is required.

YESNO

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Transportation?* This field is required.travel time plus 1$ per 1 Km

YESNO

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By selecting YES, I am giving my consent for the staff at Wonder Kidz to transport my child in their vehicle.* This field is required.

YESNO

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Transportaion?* This field is required.

Pick Up from home only

Drop Off home only

Both

Parents will transport

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Billing Out of ?* This field is required.

Core Funding : Social activities

Capacity building: Therapy

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I acknowledge that my child will need to bring a snack, a packed lunch, a water bottle and spare clothes that are clearly labelled with my child's name.* This field is required.

YESNO

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I acknowledge that a CARE plan must be completed prior to the school holidays.* This field is required.

YESNO

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Emergency Contact Name* This field is required.

First Name

Last Name

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Emergency Contact Phone Number* This field is required.

Please enter a valid phone number.

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Form filled by:* This field is required.

First Name

Last Name

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Date* This field is required.

Date