Rock Climbing - Expression of Interest

This expression of interest / intake form is to ensure that our rock climbing group program will meet your needs.

Child’s Full Name: (required)

Child’s Age (required)

Which Term 2 Rock Climbing group at Pulse Climbing Warners Bay are you interested in? (required)

Your Name (required)

Email address: (required)

Mobile (required)

What are you hoping your child gets from participating in this group? (required)

What goals would you like your child to work on in the group? (required)

Are these goals related to your NDIA goals? (required)

YesNo

How will you pay for the group program? (required)

Self Managed - NDIS (please send me an invoice)Plan Managed - NDIS (please send me an invoice)Agency Managed - NDISPrivately fundedOther

What communication support does your child need to make sure their needs are met in the group? (required)

What support would you like for your child’s mobility needs to ensure their needs are met in the group? (required)

Does your child have a diagnosis and/or what other important information would you like us to know?

Does your child have any sensitivities or situations that make them feel uncomfortable or unsafe that we can look out for and provide support for? (required)

Does your child have any allergies? (required)

Send