My Turf Autism Camp Expression of Interest Form

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Participant Name

First

Last

Date of Birth

Participants need to be between 5 and 14 years old.

Gender Identity

Does the participant identify as Aboriginal or Torres Strait Islander?

Parent/Guardian 1 Name

First

Last

Parent/Guardian 2 Name

First

Last

Optional

Mobile Number

Address

Sibling 1: Name

Sibling 1: Age

Sibling 2: Name

Sibling 2: Age

Sibling 3: Name

Sibling 3: Age

Is there a language other than English spoken at home?

Language spoken at home

If yes, which language/s?

Does the participant have a current NDIS plan?

Participant Reference Number

If yes, what is their Participant Reference Number?

How is the participant's NDIS plan managed?

Plan manager

If plan-managed, please include the name and contact details of the plan manager

Please outline the participant's NDIS goals:

My Turf Autism Camp Expression of Interest