LEARNING POD GROUP

NDIS ENROLMENT FORM

CONTACT DETAILS

PARENT / GUARDIAN *

RELATIONSHIP TO CHLID

MOBILE *

EMAIL *

ADDRESS *

HOW DID YOU HEAR ABOUT US?

STUDENT DETAILS

NAME OF CHILD *

YEAR LEVEL *

DOB *

DIAGNOSIS/ CONDITION ( eg. Sensory, Behaviour, Possible / Diagnosed / Suspected Conditions - Dyslexia, ADHD, Autism, OTHER )

NDIS goals:

Your Goals

Participants Goals:

Participant’s Likes:

Participant’s dislikes:

Challenging Behavior/Triggers:

De-escalation strategies :

COMMENTS

DOCUMENT UPLOAD - If Applicable (EG. Diagnoses, School Reports)

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SESSION DETAILS

BOOKING IN:

INDIVIDUAL 1:1 CAPACITY BUILDING SESSIONS

If you are wanting to talk to us about customised sessions to support Individual capability building sessions focusing on life skills, daily living and improved relationships tailored to your needs and Goals.

MOVEMENT AND WELLBEING GROUP

Fun capacity building through the incorporation of movement to help with breathing, mindfulness,anxiety management and relationship strategies for emotional self-regulation and awareness including yoga, sensory diet, dance, and core strength building. Empowering resilience skills for life. Smooth moves to get your grooves happening.

Term 4 Times

TEEN READINESS - COMMUNITY PARTICIPATION GROUP

This is designed to empower our teens ready for young adulthood. Developing skills to support social engagement, cyber safety, budgeting, first aid, cooking and nutrition, community numeracy and literacy for official documents. Public transport and road safety for Learner plates. CV writing and applications with workplace communication education. Teens ready to take on the world of funky adulthood.

Term 4 time

PEER FRIENDSHIPS – SOCIAL SKILLS GROUP

Groups are inclusive of friendship games, social skills, learning about core values and fun participation. Interacting with peers with facilitated role play and activities in unwritten social skills. Understanding emotions and personal wellbeing for positive community involvement.Focused to create social skills and friends for life. Lots of laughs and dab memorable moments.

Term 4 times

LIFE SKILLS SESSIONS

This group is to focus on everyday life milestones for self-empowerment around numeracy and literacy skills such as fine motor handwriting skills and curriculum foundations. Money recognition, shoelace tying, personal hygiene skills and transition resilience. Emotional connection through zones of regulation and speech development. Sessions are quirky, zesty and calming.

Term 4 times.

EARLY INTERVENTION - PARENT & CHILD GROUP

Child development for 0-6 years groups facilitation with parents. Fine and Gross motor skills fun to support speech, movement, vestibular and spatial movement awareness with social skills for early development.

Term 4 times:

PAYMENT DETAILS

PAYMENT OPTION *

INVOICE PER TERM ( eg.10 sessions per term ) DIRECT DEBIT PAYMENT PLAN ( eg. calculation 4 x Terms (40 sessions ) paid over 52 weeks a year plus a $25 set up fee ) NDIS ($450 initial fee, reports plus $150 yearly review plan - Costs per plan / goal requirement )

NDIS DETAILS

PLAN NUMBER

CONFIRMATION

I acknowledge by enrolling today you are NOT bound to a contract. Learning Pod Group will be in contact with you to arrange appropriate session times.

*

By signing this form, I acknowledge the Terms and Conditions of Learning Pod Group and agree all the information is true, correct and understood. *

I allow Learning Pod Group to set up service agreement as per information above. *

Comments:

Signature of parent / guardian

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OFFICE ONLY:

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