• Group Program- Interest Form

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Please complete if the participant is under 18 years of age, has a Public/Legal Guardian or Representative, has a Plan Nominee

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferred Method of Contact
  • Communication Channels
  • Program(s) of Interest*
  • Does the participant require 1:1 supports?
  • Health & Safety - Does the participant have any of the following
  • Is funding currently available for this program?
  • Goals
  • Program Expression of Interest – Important Information
    Thank you for expressing your interest in Haven Therapeutic Services group programs.

    Please read the following information carefully before submitting your Expression of Interest.

    Expression of Interest
    Submitting this form does not guarantee a placement in a program. Expressions of Interest are used to determine demand and assist Haven Therapeutic Services in planning future group programs.

    Programs will only proceed where minimum participant numbers are achieved. Haven Therapeutic Services reserves the right to postpone, reschedule or cancel a program if sufficient participant numbers are not reached.

    Program Confirmation
    Support Coordinators, participants and/or their nominees will be advised of a tentative commencement date once sufficient interest has been received.

    Confirmed placements will generally be offered a minimum of two (2) weeks prior to the commencement of a program.

    If a placement is offered and declined, the position may be offered to the next participant on the waitlist.

    Program Facilitators
    Most programs will be facilitated by a Positive Behaviour Support Practitioner and a Support Worker.

    Food and cooking-based programs will be facilitated in collaboration with a qualified Chef and Support Workers.

    Program Costs
    Program costs are not listed on this Expression of Interest form.

    As many programs involve resource costs, venue hire, equipment, materials and, in some cases, groceries and food supplies, pricing may vary between programs and locations.

    Confirmed pricing and funding information will be provided to Support Coordinators and/or participants prior to placement confirmation to ensure suitable funding is available and approved.

    Program Duration
    All programs will consist of a minimum of weekly sessions.

    The duration, frequency, location and session length will vary depending on the program.

    Specific details regarding session times, dates, locations and duration will be provided by Haven Therapeutic Services prior to confirmation of placement.

    Attendance and Cancellation Policy

    Program fees are calculated based on group participation and include facilitator costs, venue costs, resources, equipment and program materials purchased specifically for participants.

    Once a placement has been confirmed, program fees remain payable regardless of attendance.

    Participants who choose not to attend a session, are absent due to illness, holidays or other reasons, or withdraw after confirming their placement may still incur program fees.

    Where a participant withdraws from a program and Haven Therapeutic Services is able to fill the vacant position with another participant, fees will only be payable for the sessions attended prior to withdrawal.

    The replacement participant will then assume responsibility for the remaining program costs.

    Where a vacant position cannot be filled, the original participant may remain responsible for the full program fee due to costs already incurred and the inability to refill the position at short notice.

    Haven Therapeutic Services will make reasonable efforts to offer vacant positions to participants on the waitlist wherever possible.

    Group Sizes
    Group sizes vary depending on the program.

    Social group programs, including girls' and boys' social groups, are generally limited to a maximum of six (6) participants to ensure a high level of support and engagement.

    Other programs may have different participant capacities depending on venue requirements and program design.

    Cooking Programs
    Cooking programs will be conducted within commercial kitchen environments and participants must comply with all food safety, hygiene and workplace health and safety requirements.

    Participants attending cooking programs will be required to:

    • Wear enclosed footwear at all times

    • Wear long pants

    • Wear a shirt with sleeves

    • Wear a hairnet, hat or other approved hair covering

    • Follow all instructions provided by staff, chefs and venue personnel

    For hygiene and food safety reasons, participants are expected to attend cooking sessions in a clean and hygienic condition.

    Participants who do not meet venue safety requirements may be unable to participate in practical cooking activities.

    Participant Suitability
    To ensure the safety and success of all participants, Haven Therapeutic Services reserves the right to assess participant suitability for individual programs.

    Additional information may be requested to determine whether a program is an appropriate fit for a participant's goals, support needs and group compatibility.

    Photography and Media
    Separate consent will be sought for any photographs, videos or promotional material involving participants. Participation in photographs or marketing activities is entirely voluntary.

    Acknowledgement
    By submitting this Expression of Interest, I acknowledge that:

    • Submission of this form does not guarantee placement in a program.

    • Programs require minimum participant numbers to proceed.

    • Program dates, locations and pricing are subject to change.

    • Program costs and funding requirements will be confirmed prior to placement.

    • Attendance and cancellation conditions may apply once placement has been confirmed.

    • Haven Therapeutic Services may contact me to discuss participant suitability, funding requirements and program availability.

  • I acknowledge that I have read and understood the Program Expression of Interest Information and Conditions.*
  • Would you like to receive information about future Haven Therapeutic Services programs and events?*
  • Should be Empty: