Pre-Program Questionnaire
To find out whether your child might be suitable for a Resilience Kit group program, please complete the form below.

This form is a screening tool and does not confirm your child's enrolment. After receiving your information, we will contact you to confirm suitability.

Once you have submitted this form, you can expect contact from us via phone within one business day.

Privacy Policy: www.resiliencekit.com.au/mental-health/privacy-policy/
Child's name *
Child's age *
Child's date of birth *
Child's school and year group
Your name *
Your phone number and best time to reach you *
Your email address *
Your suburb
Please list any concerns you have about your child. *
Is your child currently receiving any additional support? *
What are your child's strengths? *
What are your child's hobbies and interests? *
Is there anything else that you can think of that can help us understand where your child is at? *
What would you like your child to achieve by the end of the program? *
How did you hear about us? *
Required
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