Expression of Interest for WRTS Adelaide and Christies Beach

Expression of Interest for WRTS Adelaide and Christies Beach
Participant's Name

First NameLast Name
Email
example@example.com
Participants NDIS number
Which location are you interested in?

WRTS KilkennyWRTS Christies Beach
Has the participant had a Service Agreement completed by their parent/ representative?

YesNo
If 'No' please complete Service Agreement here.
Has the participant had a Risk Assessment completed by their parent/ representative?

YesNo
If 'No' please complete Risk Assessment here.
What ratio support do you suggest would be best for the participant? This will be discussed with you and determined during induction.

1:1 (1x staff member to 1x participant)1:3 (1x staff member to 3x participants)
In the below sections please provide as much detail as possible so we can provide an accurate quote and a tentative booking in a timely manner.
- To purchase and pay for an Open Play Multi-pass outright please click on here .
  
  If you wish to have a multi-pass invoiced to the participants Plan-Manager please ensure a Service Agreement has been complete and tick one of the below options
- What Open Play multi-pass option are you interested in purchasing?
  
  12 x 2 hour for $2006 x 2 hour for $10012 x 1.5 hour for $1506 x 1.5 hour for $7512 x 1 hour for $1006 x 1 hour for $5010 x Unlimited Monday-Wednesday 9am-2pm $100
- We Rock The Spectrum Adelaide and Christies Beach offer after school support at 1:1 and 1:3 ratio Monday - Friday 2:30-6pm. We can work with you to provide pick up and drop off options from school and home. Please give as much detail a possible below eg. if their is a certain time period you would the dates between or for the duration of the plan etc.
- Frequency
  
  WeeklyFortnightlyother
- Days
  
  MondayTuesdayWednesdayThursdayFriday
- Duration
  provide times for each day eg. 3pm-4:30pm
- Transport- Will the participant require pick up and or drop off from school and/or home?
  
  Pick upDrop offNo- they will be dropped to We Rock and collected from We Rock
- Provide details
  If transport is requested please give name and address and time eg. Pick up from School's name and address at time; drop off at 'home address' at time.
- We Rock The Spectrum Adelaide and Christies Beach offer social groups on Saturdays we provide support at 1:1 and 1:3 ratio 9:00am-5:00pm. We can work with you to provide pick up and drop off options from. As part of this group we also offer Excursions occasionally. Excursions will incure transport costs and may incur extra costs such as entry fees which will not be covered by NDIS. Please give as much detail a possible below eg. if their is a certain time period you would the dates between or for the duration of the plan etc..
- Frequency
  
  WeeklyFortnightlyother
- Days
  
  WednesdaySaturday
- Duration
  provide times for each day eg. 3pm-4:30pm
- Transport- Will the participant require pick up and or drop off from school and/or home?
  
  Pick upDrop offNo- they will be dropped to We Rock and collected from We Rock
- Provide details
  If transport is requested please give name and address and time eg. Pick up from School's name and address at time; drop off at 'home address' at time.
- Is the participant interested in excursions (Saturday's only)
  
  YesNo
- What types of excursions?
  
  parks/ playrgoundsswimmingmuseumsbeachlibrarycommunity events
- We Rock The Spectrum Adelaide and Christies Beach offer school holiday support programs at 1:1 and 1:3 ratio Monday - Friday 8:00-6pm. We can work with you to provide pick up and drop off options from school and home. Please give as much detail a possible below eg. if their is a certain time period you would the dates between or for the duration of the plan etc.
- Frequency
  
  WeeklyFortnightlyother
- Days
  
  MondayTuesdayWednesdayThursdayFriday
- Duration
  provide times for each day eg. 8pm-4:30pm
- Transport- Will the participant require pick up and or drop off from school and/or home?
  
  Pick upDrop offNo- they will be dropped to We Rock and collected from We Rock
- Provide details
  If transport is requested please give name and address and time eg. Pick up from School's name and address at time; drop off at 'home address' at time.
- We Rock The Spectrum Adelaide and Christies Beach offer respite supports (Break time) and mentoring supports at 1:1 ratio (enquire about 1:2 and 1:3 ratio supports if you have a small group who would like support together) Monday, Tuesday, Thursday, Friday and Sunday. These supports are tailored to the individuals needs. We can work with you to provide pick up and drop off options from school, home or community location. Please give as much detail a possible below eg. if their is a certain time period you would the dates between or for the duration of the plan etc.
- Frequency
  
  WeeklyFortnightlyother
- Days
  
  MondayTuesdayThursdayFridaySunday
- Duration
  provide times for each day eg. 8pm-4:30pm
- Transport- Will the participant require pick up and or drop off from school and/or home?
  
  Pick upDrop offNo- they will be dropped to We Rock and collected from We Rock
- Provide details
  If transport is requested please give name and address and time eg. Pick up from School's name and address at time; drop off at 'home address' at time.
- We Rock The Spectrum Adelaide and Christies Beach offer respite supports (Break time) and mentoring supports at 1:1 ratio (enquire about 1:2 and 1:3 ratio supports if you have a small group who would like support together) Monday, Tuesday, Thursday, Friday and Sunday. These supports are tailored to the individuals needs. We can work with you to provide pick up and drop off options from school, home or community location. Please give as much detail a possible below eg. if their is a certain time period you would the dates between or for the duration of the plan etc.
- Frequency
  
  WeeklyFortnightlyother
- Days
  
  MondayTuesdayWednesdayThursdayFridaySaturdaySunday
- Duration
  provide times for each day eg. 1:00pm-2:00pm
- Should be Empty: