Neurodivergent Youth Board Game Registration Form

Neurodivergent Youth Board Game Club Registration Form
Please read the Information Booklet below
Child's full Name

First NameLast Name
What is your Child's Date of Birth
What is your Child's NDIS number? (If they have an NDIS plan)
Primary Caregivers Full Name

First NameLast Name
Primary Caregivers Email
example@example.com
Primary Caregivers Phone Number
Please enter a valid phone number.
Secondary Caregiver / Secondary Emergency Contact

First NameLast Name
Secondary Contact/ Emergency Contacts Relationship to child
Secondary Contact / Secondary Emergency Phone
Please enter a valid phone number.
What email should the invoice be sent to? (Your email or a NDIS plan manager if you have one)
Which Session will your child attend?

Session 1 - Thursday 10th July 1.30 - 2.30pmSession 2 - Thursday 17th July 1.30 - 2.30pm
What are your child's pronouns?

She/HerHe/HimThey/ThemOther
Can you tell me a little about your young person?
What are their interests?
Does your child have any sensory needs I need to be aware of? (e.g., touch sensitive, smell sensitive, movement seeking, need for regular breaks). Please make sure to bring any tools they need to the sessions (e.g., headphones).
Is there anything else I should know about your child that may be relevant in the group?
By signing this registration form you are agreeing that you:
- Have read the Information package in its entirity.
- Have emailed admin@familiesfirst.com.au if you have any questions or concerns.
- Are aware of the price of $64.66 per session and that you are responsible for this payment.
- Payment is due within 10 days of the group.
- Are aware of the 7 day notice cancellation policy (7 days notice or 50% of the cost).
- Have provided information relevant to your child in this form.
- Consent for your child's first name and interests to be included in the social story to be sent out 1 week before the group, to help with everyone knowing what to expect when attending the group.
Your Signature

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Neurodivergent Youth Board Game Club Registration Form