Teen After School Club Interest Form

Teen After School Club Interest Form
Welcome to the Teen After School Board Game and Art Club Interest Form!

This club is designed for connection and skill-building in a safe, low-pressure environment. Please use this form to register your interest and help us set the perfect schedule.
Parent & Teen Details
Parent/Carer Full Name:

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

First NameLast Name
Teen's Date of Birth:

MonthDayYear
Date
Funding & Support
Is your teen planning to use NDIS funding for this program?

YesNoUndecided
Does your teen require dedicated 1:1 support or specialized supervision to participate safely in a 2-hour group setting?

Yes, 1:1 support is necessary.No, they can participate in a small group setting without dedicated 1:1 support.
Vote for Your Preferred Schedule!
What is the main goal you hope this club achieves for your teen?

Building social connection / friendships.Improving impulse control / frustration tolerance.Developing leisure skills / creative expression.Finding a safe, low-stress environment.
Which day/s are you most available for the 2-hour session?

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

Mid-Afternoon (4:00 PM – 6:00 PM)Other
Thanks for your time.
Should be Empty:

Parent & Teen Details