REQUEST TO JOIN OUR SCHOOL HOLIDAY PROGRAM

Fill in the details below and one of our friendly team members will get back to you with more information about our school holiday sessions and how you can join our incredible programs. New clients will be accessed for suitability for 1:1 or 1:2 rate.

Participants Full Name

Participants Date of Birth

Gender:

Guardian Name

Guardian Last Name

Phone *

Email *

Address

Street Address

City

State

Country

Postal code

How are your NDIS funds managed:

Self-Managed

Plan-Managed

NDIA-managed (Agency-managed)

Privately Funded

NDIS Number:

Primary Diagnosis (please describe):

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