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Sense Rugby WA Sign Up

Child's name:*
Child's DOB:*
Parent/Carer name:*
Phone number:*
Which Sense Rugby Location would you like to sign up for:
Do you have any specific goals you would like us to work on with your child?
Any tips to help your child feel comfortable enough to participate? Please let us know if you have any strategies that you know usually works in group situations.
Any relevant diagnoses or medical history?
Are there any activities you would prefer your child does not participate in?
How would you like to pay?
Funding used, if applicable
If the answer is yes to any of the below questions, please provide more details and let us know how we can help manage this: Any allergies? Does your child experience seizures? Any medication? Does your child need support with communication? Does your child have a tendency to become anxious, aggressive or run away?
Upload a File:
NDIS number if applicable:
Are you self-managing your NDIS funds?
Please provide the contact details of your planner if we are required to invoice a Plan Manager.
Expiry Date:
Do we have permission to use your child's photos on our social media pages?
I give permission for my child or ward to participate in the Sense Rugby program. While I understand the efforts made by Sense Rugby Pty Ltd to minimize the possibility of injury, I understand that there will remain some degree of risk inherent in participation in the program. Please type your name in the box.