Small-Group Sessions Expression of Interest
Kia Kaha FlowMotion™ Hub
Whānau / Parent Contact
Whānau / Paren Name:
First Name
Last Name
Email Address
example@example.com
Phone Number
Format: 000-000-0000.
Child Details
Child's First Name
Child's Age / Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Availability
Morning sessions
Afternoon sessions
Who will accompany the child?
Please Select
Parent / Whānau member
Support Worker / Nanny
Educator / Learning Assistant
Primary Focus or Goals (A brief note on what functional movements or skills you'd love to focus on.)
Submit
Should be Empty: