Juniors Xperience - Expression Of Interest

Have you attended a Play On/WADSA event before?*

I have attended a Play On / WADSA event before

This is my first time

Please check the box below if you are applying on behalf of the person participating in the Xperience.*

A family member or guardian

An agency or plan manager

Other

What is your relationship to the participant? i.e. parent, plan manager etc.*

Firstname*

Surname*

Phone*

Email*

Date form completed*

Participant details

First Name*

Last name*

Phone*

Email for all correspondence*

Street Address*

Suburb*

Postcode*

Date of Birth

Please provide details of your disability.

Please select the required support ratio.

1:1

1:2

1:3

1:4

Funding

Do you receive NDIS funding?

Yes

No

First Name*

Last name*

Phone*

Email*

Date of your next plan review

Day

Month

Year

Name*

Phone*

Email*

Choose a Junior Xperience

Please select the Junior Xperience you would like to attend.

Goals

How did you hear about Play On Junior Xperiences?

CAPTCHA

Juniors Xperience – Expression Of Interest

Participant details

Funding

Choose a Junior Xperience

Goals