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New Participant Form
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School Holiday Farmers Form
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INTAKE - School Holiday Farmers Form
School Holidays on the Farm is a whole lot of fun! Farm animals, horse riding, bush camp, nature crafts and more. Please ensure to fill out the new participant form if the participant will be AGENCY or NDIS funded for this program.
Participant Full Name
Date Of Birth
Address
Parent / Guardian Name
Phone Number
Emergency Contact - Name and Phone Number
Email
APRIL SCHOOL HOLIDAYS 2025
Week 1
Days & Times Requesting :
Tuesday 8th April 10am - 3pm
Wednesday 9th April 10am - 3pm
Thursday 10th April 10am - 3pm
Friday 11th April 10am - 3pm
Week 2
Days and Times Requesting :
Tuesday 15th April 10am - 3pm
Wednesday 16th April 10am - 3pm
Thursday 17th April 10am - 3pm
JULY SCHOOL HOLIDAYS 2025
Week 1
Days and Times Requesting :
Tuesday 8th July 10am - 3pm
Wednesday 9th July 10am - 3pm
Thursday 10th July 10am - 3pm
Friday 11th July 10am - 3pm
Week 2
Days and Times Requesting :
Tuesday 15th July 10am - 3pm
Wednesday 16th July 10am - 3pm
Thursday 17th July 10am - 3pm
Friday 18th July 10am - 3pm
SEPTEMBER SCHOOL HOLIDAYS 2025
Week 1
Days and Times Requesting :
Tuesday 23rd September 10am - 3pm
Wednesday 24th September 10am - 3pm
Thursday 25th September 10am - 3pm
Friday 26th September 10am - 3pm
Week 2
Days and Times Requesting :
Tuesday 30th September 10am - 3pm
Wednesday 1st October 10am - 3pm
Thursday 2nd of October 10am - 3pm
Friday 4rd of October 10am - 3pm
Are you an existing Fearless Farmhouse participant?
NDIS Funded?
Yes
No
NDIS Number
Group Participation Level
1:1 staff required to participate in a group activity
Capable to participate in group activity no assistance required
A little extra assistance required
Any additional needs or requirements
Does the participant require any medications? [If Yes, a medications form will be required and we will email this to you]
Yes
No
Submit
