Exit
Please complete this enquiry form and CCF will contact you to discuss your child's outside school hours care.
Parent / Carer Contact Details

Question Title

* 1. Title

Question Title

* 2. First Name

Question Title

* 3. Last Name

Question Title

* 4. Phone number

Child 1: Details

Question Title

* 6. Child’s / Participant’s First Name

Question Title

* 7. Child’s / Participant’s Last Name

Question Title

* 8. Child’s / Participant’s NDIS Number and plan dates

Question Title

* 9. Child’s / Participant’s date of birth

Date

Question Title

* 10. Child’s / Participant’s gender

Question Title

* 11. Child’s / Participant’s school (if applicable)

Question Title

* 12. Child’s / Participant’s allergies and dietary requirements

Question Title

* 13. Child’s / Participant’s diagnosis (please also include any significant medical conditions e.g. epilepsy)

Question Title

* 14. Child’s / Participant’s Medications (please provide full details of any medications that need to be administered during support hours. If applicable, ensure medications are provided in a Webster Pack for accurate and secure dosing. A Sign-In and Sign-Off Sheet must also be completed to document administration)

Question Title

* 15. Child’s / Participant’s day to day strengths and limitations (optional)

Question Title

* 16. Child’s / Participant’s Behaviour Support Plan and any other reports (e.g. occupational therapy, any restrictive practices)

Question Title

* 17. Please upload the Child’s / Participant’s Behaviour Support Plan and any other reports (e.g. occupational therapy, any restrictive practices)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Child 2: Details
Please complete Questions 18-29 if you are enquiring for two children.

Note: For enquiries concerning more than two children, please submit a new enquiry form.

Question Title

* 18. Child’s / Participant’s First Name

Question Title

* 19. Child’s / Participant’s Last Name

Question Title

* 20. Child’s / Participant’s NDIS Number and plan dates

Question Title

* 21. Child’s / Participant’s date of birth

Date

Question Title

* 22. Child’s / Participant’s gender

Question Title

* 23. Child’s / Participant’s school (if applicable)

Question Title

* 24. Child’s / Participant’s allergies and dietary requirements

Question Title

* 25. Child’s / Participant’s diagnosis (please also include any significant medical conditions e.g. epilepsy)

Question Title

* 26. Child’s / Participant’s Medications (please provide full details of any medications that need to be administered during support hours. If applicable, ensure medications are provided in a Webster Pack for accurate and secure dosing. A Sign-In and Sign-Off Sheet must also be completed to document administration)

Question Title

* 27. Child’s / Participant’s day to day strengths and limitations (optional)

Question Title

* 28. Child’s / Participant’s Behaviour Support Plan and any other reports (e.g. occupational therapy, any restrictive practices)

Question Title

* 29. Please upload the Child’s / Participant’s Behaviour Support Plan and any other reports (e.g. occupational therapy, any restrictive practices)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Question Title

* 30. Please indicate below the programs you are interested in

Question Title

* 31. Please select the location where you need the program or support

Question Title

* 32. How did you hear about our services?