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*

DD

MM

YYYY

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

DD

MM

YYYY

Goals

Please select the goals you hope to achieve by attending a All Abilities Recreation event.

Improving your health and wellbeing

Increase your community participation

Increase your independent participation in activities

Learn new skills

Make new friends

Other

Select a session

Which All Abilities Recreation session are you interested in?

Select a term

Which All Abilities Recreation term/s are you interested in?

How did you hear about WADSA All Abilities Recreation?

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Xperience – Expression Of Interest

Participant details

Funding

Goals

Select a session

Select a term