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Please complete details and our team will contact you
Parent/Guardian Details:
First Name:
Email:
Phone/Mobile:
Participant (Dependent/Child):
First Name:
Age:
5 - 6
7 - 8
9 - 11
12 - 14
15 - 17
18 - 20
21 - 25
26+
Suburb:
Postal Code:
Health Conditions:
Help us to know more about the participant:
(Tick all that apply)
Requires Assistance to Walk
Struggles with Incontinence
Has Help to Use the Bathroom
Can be Aggressive or Violent
History of Running Away
Other Challenging Behaviours
Communicates Non-Verbally
Severe Sensory Difficulties
N/A
What type of services are you interested in:
(Tick all that apply)
Motor Assessment
Exercise Physiology
Personal Training (One on One)
Athlete Development
Small Group Training
Holiday Immersion Programs
When would you like to train with us:
(Tick all that apply)
Before School Hours
During School Hours
After School Hours
Saturdays
Sundays
School Holidays
How are you funded:
(Tick the most relevant)
Privately Funded
NDIS Self-Managed
NDIS Plan-Managed
NDIS NDIA-Managed
Submit
Thank you for your inquiry through our website. Our Medical and Allied Health team will review your submission and be in contact shortly.
