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Star Compass Program Signup

Creative Program

What day will the participant be attending?

What is the participant's full name?

Full name of person completing this form

Your relation to the participant:

Contact number:

Contact email:

Participant NDIS number:

NDIS plan manager contact details: (name, telephone, email, company)

Does the participant have any dietary requirements?

Does the participant have any other special requirements?

Does the participant have any other special requirements?

Wheelchair Access Required

Assistance With Walking or Mobility

Sensory Preferences (eg. visual, hearing, textures, easily overwhelmed)

Communication/Translation Support

Medical and Health Considerations (eg. medicine, epilepsy support, allergies, personal care)

Behavioural or Psychological Support

Other

Please specify:

Does the participant require transport?

Does the participant give consent to attend?

Does the participant give media release consent?

Signature

Signature