NAPA Wellington Open Day Interest Form
Saturday 25th July 10am - 2pm
Please indicate your interest in the Open Day
*
I am a parent/carer
I am a therapist/student interested in learning more
Other
Name of Parent/Carer
*
First Name
Last Name
Parent/Carer Email
*
example@example.com
Parent/Carer Contact Number
*
Best contact number
Child's Name:
*
First Name
Last Name
Child's Age
*
DDMMYY
Diagnosis/presentation:
*
Tell us a little bit about your child, including Diagnosis (if you have one)
Please select one of the following (select as many as apply)
*
I am interested in coming along to the Open Day for a chat with the NAPA team
I am interested in coming along to the Open Day to see the equipment suppliers (see additional question below)
I can't make the Open Day but am interested in meeting with the NAPA team or completing a Discovery session during the NAPA Wellington Pop up (July 20 - Aug 7).
Are you interested in booking a free 30-minute Discovery session with one of our NAPA therapists? (Tick all that apply)
*
Yes, between 10am - 11am
Yes, between 11am - 12pm
Yes, between 12pm - 1pm
Yes, between 1pm - 2pm
No, I am not interested in a Discovery session
If you are looking to check out any equipment in partcular, please let us know here and we will do our best to have it there on the day.
Anything else you'd like us to know?
Your Name
First Name
Last Name
Your email
example@example.com
Your contact number
-
Area Code
Phone Number
What is it you are interested in learning more about at our open day?
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