School Holiday registration form

Location: Variety of locations across Adelaide

Days: One in each week

Time: Morning to afternoon

Contact information.

If you would like to added to our School holiday program mailing list or request more information. Please complete the below form and one of James ( Operations Manager) or Rob (Client Service Manager) will be in contact.

Referral Details

Your name: *

Relation to Participant: *

Your Phone Number *

Email Address: *

Preferred form of contact: *

Participant's Details

Participants Full name: *

Participants Phone Number:

Participants email address

Participants NDIS Number: *

Preferred form of contact *

Participants plan manager: *

Any additional information

We will be in touch with you as soon as possible