Sydney Holiday Program RegistrationPlease 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 belowHoliday Program Week 1Movies (Monday 07/07/2025)Bounce Inc (Tuesday 08/07/2025)Swimming Skills (Wednesday 09/07/2025)Entertainment Park Go Karting (Thursday 10/07/2025)Virtual Room (15+ Only) Friday 11/07/2025)Holiday Program Week 2Ninja Parc (Monday 14/07/2025)Bowling/ Timezone (Tuesday 15/07/2025)Fortress gaming (Wednesday 16/07/2025)Aquarium (Thursday 17/07/2025)Castle Hill Glow Zone (15+ Only) (Friday 18/07/2025)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
