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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
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 funding?
Yes
No
What type of funding do you receive?
Individualised DOC
NDIS Funding
Not sure
Are you able to use any of this funding to attend a WADSA Play On Xperience?
Yes
No
Not sure
Do you have a Local coordinator or Support coordinator?
Yes
No
First Name
*
Last name
*
Phone
*
Email
*
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
Choose an Xperience
What 2 Play On Xperiences would you like to attend?
How did you hear about Play On Xperiences?
Post Body
Email
This field is for validation purposes and should be left unchanged.
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