School Holiday Program Booking Form
Event Timing: Wednesday 5th July
Event Address: 356 Shands Road, Main Ridge, Victoria.
Contact us at 1800 467 342 or psychology@rehab4rehab.com.au
Cost $249 Complete form first and we will phone you for payment.
50% Deposit required to secure your childs place in the program
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Email *
Your Name *
Email *
Phone Number *
Attendees Name
 *
Attendees DOB and Age
 *
Attendees Home Address (including post code) *
Does the attendee have a diagnosis, are in the process of being diagnosed, or are suspected of having a condition that may impact their ability to safely and comfortably take part in a group session? (for example, Autism Spectrum Disorder, ADHD, or Tourettes?)
 *
If you have answered Yes or Unsure to the previous question, please provide more information below.
 *
Our sessions are held on a farm with horses where there are many animals, noises, dust and plenty of opportunities to get dirty. Do you believe that the attendee will struggle to deal with any of these conditions?
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As we are on a farm in a group, it is important that our participants can follow instructions and stay with the group. Does the attendee have any problem with following instructions or running away?
 *
Attendee Dietary restrictions
 *
Would you like to subscribe to hear more from Rehab4Rehab including upcoming events and programs?
 *
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