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Xperience – Expression Of Interest
Xperience – Expression Of Interest
If you would like to take part in the Xperience please complete the following and return.
Please fill in the below form to register your interest for the event and we will be in touch soon.
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 experience
Please check the box below if you are applying on behalf of the person participating in the experience.
A family member or guardian
An agency or plan manager
Other
If you would like to take part in Xperiences program, please complete the below.
Your details
First Name
*
Last name
*
Phone
*
Email
*
Street Address
*
Suburb
*
Postcode
*
Date of Birth
DD
MM
YYYY
Please provide details of your disability.
Please select the required support ratio.
1:1
1:2
1:3
1:4
Wheelchair access
Wheelchair access is required.
Funding
Do you receive NDIS funding?
Yes
No
Are you able to use any of this funding to attend a WADSA Play On Xperience?
Yes
No
Do you have a Local coordinator or Support coordinator?
Yes
No
First Name
*
Last name
*
Phone
*
Email
*
Date of your next plan review
DD
MM
YYYY
Choose an Xperience
How many Xperiences will you have funding for in your current Plan?
How many Xperiences will you have funding for in your current Plan?
Not Sure
Please list in order of preference, the Xperience or Xperiences you would like to attend.
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
- Choose your Xperience -
Country Music Festival, 17 - 20 February 2023
Rottnest Island Escape, 14 - 17 March 2023
Rev Heads Xperience, 25 - 28 April 2023
West Coast Eagle Xperience, May 2023 TBC
Your Kitchen Rules, 9th - 12th June 2023
Christmas in July, 7th - 10th July 2023
Freo Dockers Xperience, August 2023 TBC
Gold Rush Adventure, September 2023 TBC
Bull and Barrel Festival, October 2023 TBC
Rottnest Island Paradise, November 2023 TBC
Christmas Festival, 30th November - 4th December 2023
New Years Eve Extravaganza, 30th December - 2nd January 2024
Goals
Please select the goals you hope to achieve by attending a Play On Xperience.
Improving your health and wellbeing
Increasing your independence in daily living
Building or maintaining relationships
Social and Community participation
Learning new skills
Other
How did you hear about Play On Xperiences?
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