NDIS Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Participant Name *Phone *Email *Date Of Birth *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease select programs belowWhat Program are you interested in?Select Program TypeWeekend ProgramHoliday ProgramRespite ProgramLife Skills ProgramCooking ProgramFitness TrainingLife Skills, Travel, Computer TrainingArt ProgramGo KartingHoliday Program Week 1Movie Trip (Monday 30/12/2024)Bowling/Timezone (Tuesday 31/12/2024)PUBLIC HOLIDAY - NO ACTIVITY (Wednesday 01/01/2025)Aquatopia (Thursday 02/01/2025)(AGES 13+ ONLY) - Harbour Jet Ride (Tuesday 31/12/2024)Holiday Program Week 3Ninja Parc (Monday 13/01/2025)Raging Waters (Tuesday 14/01/2025)Featherdale (Wednesday 15/01/2025)Interactive Gaming (Thursday 16/01/2025)(AGES 13+ ONLY) - Eastern Creek Go Karting (Wednesday 15/01/2025)Holiday Program Week 5PUBLIC HOLIDAY - NO ACTIVITY (Monday 27/01/2025)Symbio (Tuesday 28/01/2025)Beach Day (Wednesday 29/01/2025)Movie Trip (Thursday 30/01/2025)(AGES 13+ ONLY) - Teen BBQ (Tuesday 28/01/2025)Holiday Program Week 2Aquatic Centre (Monday 06/01/2025)Flipout (Tuesday 07/01/2025)Ferry To City (Wednesday 08/01/2025)Treetops Adventure (Thursday 09/01/2025)(AGES 13+ ONLY) - Sydney Skywalk (Tuesday 07/01/2025)Holiday Program Week 4Go Karting ( Monday 20/01/2025)Kayaking (Tuesday 21/01/2025)Cables Aqua Park (Wednesday 22/01/2025)VR Gaming (Thursday 23/01/2025)(AGES 13+ ONLY) - Luna Park (Thursday 23/01/2025)Parents/Guardian Name (if applicable)NDIS Plan Start Date * NDIS Number *NDIS Plan End Date *Funding Management *Choose Funding managementNDIA ManagedSelf ManagedPlan ManagedFill in Your Plan Manager Details (if applicable)I give consent for photographs and/or videos to be published via various forms of media such as Social media, Website, Organisational or promotional material and Education and training purposes *Please SelectYesNoI Give Permission for Me/My Child to be Picked up And Dropped by CORE ASSIST DISABILITY SERVICES *Please SelectYesNoPlease List Any AllergiesPlease List Any Medications (name, date and time)Enter The Full Name Which Serves as The Electronic Signature for This DocumentSubmit
