December 2025 Holiday Program - Expression of Interest

December 2025 Holiday Program - Expression of Interest

4-Week Intensive Development Holiday Program - December 2025Expression of Interest
Thank you

Thank you for your interest in our December 2025 Holiday Program! This small group program (maximum 6 children) provides therapeutic movement support during the busy holiday period when children with additional needs often struggle with routine changes. Complete this form to join our waiting list. I'll contact you directly with available session times and booking details.
About Your Child:
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Early Childhood Service/Holiday Care Location
Name of the early childhood service or holiday care program your child will attend. This helps us coordinate with services that agree to host the program.
Is your child an NDIS participant?

Yes - we have NDIS fundingNo - we'll pay privatelyNDIS application in progressNot sure
Does your child have any diagnosed conditions?
Eg: Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Developmental Coordination Disorder (DCD), Global Developmental Delay, Intellectual Disability, Sensory Processing Disorder, Other (please specify below), No formal diagnosis but developmental concerns
Parent/Guardian Information
Your Full Name

First NameLast Name
Your Relationship to Child:
Your E-mail
example@example.com
Your Phone Number*
Your Suburb/Location
Program Preferences
Which days work best for your family?
Preferred session time?
If yes, how is your NDIS plan managed?
Additional Information
How did you hear about us?*
If "Other", please specify:
Is there anything else you'd like me to know about your child or family?
Any additional information that would help me support your child effectively (e.g., specific triggers, communication preferences, medical considerations)
Would you like to receive updates about other Play Move Improve services?

Yes, keep me informed about webinars, workshops, and programsNo, only contact me about the December Holiday ProgramMaybe
Parent/Guardian Information

Here's what happens next:

Within 48 hours: I'll email you with:

* Available session times and specific dates
* Detailed program information
* Payment and booking instructions
* Answers to any questions you may have

Important: Submitting this form does not guarantee a spot. With only 6 spaces available, places are allocated on a first-come, first-served basis once booking opens.

Questions in the meantime? Email: robyn@playmoveimprove.com.au

I look forward to supporting your child's development!
Should be Empty:

December 2025 Holiday Program - Expression of Interest

Thank you

About Your Child:

Parent/Guardian Information

Program Preferences

Additional Information

Parent/Guardian Information