Workshop Expression of Interest
This form allows for Bright Star Support Services to keep a list of numbers to allow for attendance and also wait lists for programs.
Full Name of Participant
*
First Name
Last Name
Full Name of parent/carer if Participant is under 18
First Name
Last Name
NDIS Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact name (Different to parent if being filled out by parent)
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Client
*
NDIS invoicing
*
Self-Managed
Plan-Managed
Agency- Managed
Privately Funded
Workshop you are interested in:
Dungeons and Dragons
Imaginative Clay-Works
Emotional-CPR Training
Understanding Autism from a Neurodivergent Voice.
Other (if not known)
Please add any more information you would like to know
Submit
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