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PARTICIPATE
PARTICIPATE is a program that has been designed using the latest research in childhood disability that aims to promote inclusion and community for better health and well-being to ultimately enhance quality of life. PARTICIPATE aims to modify the activity and equipment to promote inclusion for people with all abilities.
TERM 3 2022 DATES: Weekly on Thursdays 28th of July to the 1st of September (inclusive).
TIMES: 4:00pm till 5:00pm
SOUTH PERTH COMMUNITY CENTRE
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* Indicates required question
Child's Name
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Your answer
Parent/Carer Name
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Your answer
Contact Phone Number
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Your answer
Email address
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Your answer
Child's DOB
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MM
/
DD
/
YYYY
Main diagnosis
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Your answer
What funding program will you be accessing?
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NDIS Self Managed
NDIS Agency Managed e.g. Ability Centre, Rocky Bay, Therapy Focus ** Please provide additional information below **
NDIS Fund Managed e.g. NDSP, My Plan Manager, Plan Partners
Self Funded
Other:
If you are under the NDIS, please provide your child's NDIS number. If this is not applicable, please write "N/A".
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Your answer
If you are under the NDIS, please provide the name of agency or fund manager and the finish date of your NDIS plan. If this is not applicable, please write "N/A".
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Your answer
The PARTICIPATE program includes a "plus one". This could be your child's friend or sibling (must be school aged). Who will this be?
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Your answer
Additional comments or queries
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