Holiday Zone Form Temporary

Holiday Zone

Centre-based programCommunity-based programSiblings program
For children living with disabilityFor children living with disabilityFor siblings of children living with disability
Centre-basedCommunity-basedCommunity-based
Full dayPart dayPart day
14 to 18 January21 to 25 January14 to 25 January
$10 each day + your child's NDIS or self-funded packageFREEFREE
A jam-packed, full-day, centre-based program of sport, cooking, arts and crafts, and outdoor activities – all of which can be tailored to suit individual needs.A chance to ‘come and try’ new activities – bringing together children living with disability, school-aged mentors and specialist coaches.Activities for siblings of children living with disability.

Participant details

Please complete one form for each child

Your details

Emergency contact
Emergency contact

Consent

Participation

My child wants to attend:

Information release

Medical release

If the participant is ill or injured, I approve any necessary medical treatment to be carried out by a legally qualified medical practitioner. Should this be necessary, I understand that I will be notified as soon as possible, and I am prepared to cover all relevant costs.

Support needs

Only list support needs that are relevant to the program activities (for example, there is no need to list nighttime routines). If support needs are covered by a plan you will be sharing with Li-Ve Tasmania, simply note that there is a plan in place.

Allergies

Medication

Lifestyle

Support

By submitting this form I am confirming that the information is true, complete and correct and that I am providing my consent where shown.

Happy to help!

What can we do for you? If you need a hand or more info, get in touch via:

phone on (03) 6227 5400, email hello@livetasmania.org or visit us on facebook