Enrol New Participant Personal InformationD.O.B *Person’s name *Parent/Guardian names: *Residential Address: *Email and Phone number *Accommodation Services (if applicable) *Address *Daytime contact no. *Accommodation Email *No. of days requestedMonTueWedThuFriSatSunTrial day required? *YesNoDoes Participant Require Transport? *YesNoType of Disability and Level of Support Needs (medium, high etc) *If Known, How Will You Pay for the Service? *DCSI FundingNDIS FundingSelf FundingDo you have a current NDIS Plan?Participant Number:Plan Start and End Dates:Managed by:SelfPlanNDISSpecific support requirementsToiletingMobilityMedicationsCommunication Verbal/writtenBehaviouralDietAllergiesAdditional InfoLCS Notes:What are his/her special interests?What activity does he/she like doing? Eg Bowling, Swimming, Music, Art, Outing, Cooking, Socialising etc…What are his/her current goals?What other goals he/she would like to achieve?Additional notes:Send Message
