Welcome

1
The name of the young person who would like to attend* This field is required.
First Name
Last Name
2
How old is the young person who would like to attend?* This field is required.
Please Select
Please Select
11 or under
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29+
3
Does the young person have an approved NDIS plan?
Yes
No, seeking private enrolment
Currently applying
I'm not sure
4
Which program is the young person interested in?* This field is required.
Move Through Life (Day Program MTTF 9:30-3:30pm)
Move Up (Employment & SLES Wednesdays)
M-Club (Afterschool Program Wedesndays)
School Holidays (Jan 2026)
Other
5
Contact Person* This field is required.
First Name
Last Name
6
Relationship to the young person* This field is required.
Please Select
Please Select
I am the young person
Parent / Carer
Allied health or support person
School / dept of education
Other
7
Your contact number
Please enter a valid phone number.
8
Your Email
example@example.com
9
Please let us know the best time for a call and will reach out as close to your preferred time as possible!If we can't reach you, we'll send you a text & an email.
10
If you would like to provide us any more helpful details about the young person, please feel free to include them below.This might be related to their needs, goals, schedule or NDIS plan. All information is welcome!
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Should be Empty: