Rebound Therapy interest registration 

Your information will be stored securely and only used for Rebound Therapy coordination purposes.

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Name of Participant  *

Has the participant done Rebound Therapy before?

 *

What disability or diagnosis does the participant have?

 *

Which day(s) would they be interested in attending?

 *
Required

What support does the participant need during sessions?

(hoist transfer, 1:1 support, visual schedule, etc.) *

Can they weight bear or do they need hoisting onto the trampoline?

 *
Required

Do they have any medical needs or risks we should be aware of?

 *

Carer/Parent/Guardian Name & Contact Info: Name

 *
Carer/Parent/Guardian Name & Contact Info: Phone number *
Carer/Parent/Guardian Name & Contact Info: Email *

Preferred method of contact

 *
Required

Anything else we should know?

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