OTFC Group - Expressions of Interest, Term 2 2023

OTFC GROUPS
Expressions of Interest
Term 2, 2023

Completing this form does not guarantee your child will secure a spot in Term 2 2023 Groups - this is an expression of interest only.

Expressions of interest close Wednesday 5th April 2023

Child's Name: *

First NameLast Name

Child's Age:*

Contact Email Address:*

example@gmail.com

Please select your status

If applicable, who is your most recent treating Occupational Therapist?

Please select groups at OTFC+ (Mile End)

Please select groups at OTFC Parkside

Please select groups at OTFC Adelaide

Please select groups at OTFC Groups - Offsite

Does you child have any allergies or dietary requirements?*

NoYes

If yes, please provide more detail?

Does you child take any acute medication e.g. Ventolin or Epipen that may need to be administered when they are engaged in a group?*

NoYes

If yes, please provide more detail?

Please make sure to bring this medication with you to every session.