PREP Ready Group Expression of Interest:

Client Details:

First Name:*

Last Name:*

Birthday*

Day

Month

Year

First name*

Last name*

Phone*

Email*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

What year will your child be starting school?*

What school will your child be attending?*

How would I like to engage:*

Face to Face Therapy

At Home Therapy Kit

Telehealth Parent Support

Is there anything special about your child’s needs that we can be aware of to help them thrive in our group?

Allergies

Cortical Visual Impairment

Injuries

Require Specialised Seating

Seizures

Vision Impairment

Other

Please note: the above points will not exclude your child from the group, but helps us to better prepare and support your child to succeed.

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