Selective Mutism Parent Training Therapy Group
Please complete the information below if you would like a place on the upcoming Selective Mutism Parent Training Therapy Group. This is a 6-session groups and you need to register for the whole programme at once.

The groups focus on a different topic each week with between session practice on your part for some sessions. We are focused on equipping parents with knowledge and skills so you can be the best coach and advocate possible for your child. This group is targeted for parents of children aged 3-7 and can be suitable for up to Yr 6 in relation to strategies and the informal sliding in approach.

At this time, group fees are only reimburseable for self-managed NDIS participants. Group fees are not reimbursable with plan or agency managed NDIS participants, medicare or private health funds. A single invoice will be provided for the group series with payment required upfront and bookings made on a first come first served basis. A receipt will be provided once payment is received. NDIS self-managed participants will be able to submit this to NDIS following completion of the last session.
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Email *
What is your name and your child's name? *
What state and country do you live in? *
Phone number *
How did you find out about this group? *
What is your relationship to the child(ren) with SM?
 *
How old is/are your child/children that you are concerned about?
 *
Has your child received therapy targeting their Selective Mutism from a treating professional to date? (Please detail) *
What do you hope to get out of attending the group? *
I confirm that I can attend all 6 sessions dated:

Tuesday 25th October @ 11.30am - What is SM

Tuesday 1st November @ 11.30am - How to talk to my child and others about SM

Tuesday 8th November @11.30am - Everyday strategies for SM #1

Tuesday 15th November @11.30am - Everyday strategies for SM #2

Tuesday 22nd November @ 11.30am - How to get started with a small steps programme

Tuesday 29th November @11.30am - Troubleshooting within a small steps programme

 *
Required
I agree that I will not record sessions and that I will avoid use of identifying information in my discussions e.g., teacher, therapist, school names so as to protect privacy for all attendees.  *
I agree to sessions being recorded by the organiser and I understand that these will be shared with group attendees on request. I agree not to share these recordings with anyone else. The organisers will not be using these videos for marketing or other purposes and the organisers will destroy their copies following the last session of the group so these will not be available after the group. Although limited recordings may be available, (subject to no technical issues) it is highly recommended that attendees join all group sessions live. *
Required
My personal information
If accepting a place within the group, my details from this form will be stored within Selective Mutism Western Australia's Client Management Record System to enable payment and record keeping for the purposes of the group. My email address will automatically be added to Selective Mutism Western Australia's mailing list for future communications.
 *
If I am utilising NDIS funds to attend, I confirm that I understand that only self-managed NDIS participants that have available funds within their plan and a relevant goal and budget e.g. Capacity Building can claim for this group. Claims cannot be made until after the last session of the group has been completed using the receipt. If you are unsure whether your can claim or not, please discuss with your NDIS planner or LAC. Selective Mutism Western Australia canot be held responsible for any claiming issues. *
Required
I understand that if I am offered a place in this group I will receive an email containing my invoice - please check junk/spam for this email, it will come from a Halaxy email address. This needs to be paid within 48 hours of receipt to secure my place in the group. A screenshot of the payment receipt is required to be sent on email to  Danielle@selectivemutismwa.onmicrosoft.com (please note capital letter for first name is required) to confirm this. If payment is not received within 48 hours the group place will be offered to the next person on the list. Reminder emails will not be sent. *
Refund Policy
A full refund will be available if a cancellation request is received in writing by Danielle@selectivemutismwa.onmicrosoft.com (please note capital letter in first name) 7 days prior to the group start date. No refunds will be available for cancellations made less than 7 days before the group start date. 
Please read our cancellation policy here and confirm that you agree to this below.
 *
I agree to log into the first group 15 minutes before the meeting start time to enable troubleshooting and avoid unneccessary delays. The therapists will call me on my mobile if I have not logged in within this timeframe. *
I hereby state that I have read and understood the above terms and conditions and agree to abide by them.
Please write your (parent/guardian) full name below.
 *
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