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Adaptive and Inclusive Aerial & Circus Questionnaire
Dear Parents, thanks for taking the time to fill in the below details to help us provide the best classes we can for your child. Regards, Carlie & Brie
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Email
*
Your email
Who is filling this form out?
*
Participant
Parent
Guardian
Carer or Support Worker
NDIS Provider
Other:
Participant Name
First and last name
Your answer
Participant Date of birth
Your answer
Contact Name (if necessary)
First and last name
Your answer
Client contact Email
Your answer
Client Phone
Your answer
What are you looking for? (select as many as apply)
Private Adaptive Lesson - Ground or air based
Inclusive/Adaptive Class
Kids Aerial Arts class
Kids Aerial Arts class with Carer
Adults Aerial Arts Class
Adults Aerial Arts Class with Carer/Companion
Clear selection
Are there medical/physical conditions that we need to be aware of?
Your answer
Are there particular behavioural issues that we need to be aware of group setting?
Your answer
What are your/their current physical capabilities and/or restrictions?
Your answer
How do you/they best communicate?
Your answer
How do you/they prefer to learn?
Your answer
Are there any social / emotional / physical goals that you are working towards?
Your answer
Is there anything else you would like us to know about ahead of class time, to help this be the best experience for you?
Your answer
We are happy to invoice for Self-Managed or Plan-Managed NDIS clients, but please note that we are not currently NDIA registered. Please select which method best applies to you.
Self-Managed
Plan-Managed
Other:
Do you have a specific NDIS Code/Category you wish for us to include on your invoice? Please also include any contacts and email address we need to send the invoice to.
Your answer
Class scheduling communication method - Do you prefer us to contact via sms, phone calls or email?
Your answer
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