Tweenz Club
Saturday Friendship Group : Including transportation ( 5 or 4 hours) : Monthly starting 11th.June.22
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Email *
Tween`s Name *
Age *
Gender *
Address *
School *
Primary Carer name *
Primary Carer phone number *
Primary Carer marital status *
Is the child an NDIS participant? *
NDIS participant number *
How is the participant NDIS plan managed? *
Plan manager email : *
Participant's Primary Diagnosis *
Any siblings with additional needs? *
Sensory preferences *
Sensory triggers *
Any allergies *
Any medication *
Cultural background *
Dietary requirements *
Would you like us to be aware of anything else? *
Is the child considered *
Required dates: *
I would like activities' charges to be *
Needed ratio: *
Would you prefer the bill to be : *
Emergency Contact *
Relationships to the participant *
Contact Number *
Form filled by *
A copy of your responses will be emailed to the address you provided.
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