Group Registration

Unfortunately, we do not currently have any groups booked for 2023. Please come back to check groups at a later time.

Please select at least one option.

You understand and agree to the following terms:

I understand this is an expression of interest and services will be based on capacity and numbers for groups. Submission of this form does not guarantee access to services.
I am aware that acceptance to Groups does not mean that my child will receive ongoing services.
I am aware that groups are run over a number of sessions and agree to commit to the full program.

I Agree

Please agree to the terms to continue

Child's Name

Please enter your child's name.

Date of Birth

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Diagnosis / Medical Conditions

Please confirm child's diagnosis

Does your child have any health or medical conditions that may impact their participation in Sense Rugby? (i.e. epilepsy, heart condition)

Does your child have any allergies?

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Does your child currently receive OT services? if Yes, please list therapist and contact details.

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Are there any things that therapists need to consider when working with your child? (please tick all that apply)

May run or walk away from group
Dislikes loud noises
Dislikes touch
Enjoys deep pressure
Poor awareness of pain
Unable to ask for help (i.e. if injured or upset)
Unable to regulate own temperature (i.e.
overheats and forgets to take off jumper) Invalid Input

How does your child communicate?

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What can the team do support your child if they become overwhelmed?

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Is there any other information that you would like therapists to be aware of during the group?

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Parent/Carer Name

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Mobile

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Address

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Funding source

NDIS self managed
NDIS plan managed
NDIS agency managed
Paying privately

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NDIS Plan Dates

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NDIS Number

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Group Registration

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