Active Story Time Interest Form

Active Story Time Interest Form
Welcome to the Active Story Time Program Scheduling Survey!

Thank you for your interest in our inclusive movement and literacy program. Your feedback helps us determine the best days and times to run the groups.
Parent & Child Details
Parent/Carer Full Name:

First NameLast Name
Parent/Carer Email:
example@example.com
Parent/Carer Phone:
Please enter a valid phone number.
Child's Name:

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Are you planning to use NDIS funding for this program?

YesNo
How Can We Support Your Child's Development?
What is the main goal you would like to achieve in this program?

Supporting developmental milestones (motor, sensory).Building social skills and peer interaction.Improving literacy and language engagement.Helping with sensory regulation and focus.Other
Vote for Your Preferred Day and Time!
Which day/s are you most available for the 2-hour session?

MondayTuesdayWednesdayThursdayFridaySaturday
Which time slot generally works best for your child's session?

Morning (9:00 AM – 12:00 PM)Mid-Day (12:00 PM – 3:00 PM)Afternoon (4:00 PM - 6:00 PM)
Is there anything else we should know about your child's learning style or support needs?
Consent:*

I consent to Play Move Improve contacting me about group scheduling and enrolment details.
Thank you for your time.
Should be Empty:

Parent & Child Details