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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
EASTER HOLIDAYS APRIL 2024
Week 1
Days & Times Requesting :
Tuesday 2nd April - 10am - 3pm
Wednesday 3rd April - 10am - 3pm
Thursday 4th April - 10am - 3pm
Friday 5th April - 10am - 3pm
Week 2
Days and Times Requesting :
Tuesday 9th April - 10am - 3pm
Wednesday 10th April - 10am - 3pm
Thursday 11th April - 10am - 3pm
Friday 12th April - 10am - 3pm
WINTER SCHOOL HOLIDAYS - JULY 2024
Week 1
Days & Times Requesting :
Tuesday 2nd July - 10am - 3pm
Wednesday 3rd July - 10am - 3pm
Thursday 4th July - 10am - 3pm
Friday 5th July - 10am - 3pm
Week 2
Days & Times Requesting :
Tuesday 9th July - 10am - 3pm
Wednesday 10th July - 10am - 3pm
Thursday 11th July - 10am - 3pm
Friday 12th July - 10am - 3pm
SPRING SCHOOL HOLIDAYS - SEPTEMBER/OCTOBER 2024
Week 1
Days & Times Requesting :
Tuesday 24th September - 10am - 3pm
Wednesday 25th September - 10am - 3pm
Thursday 26th September - 10am - 3pm
Friday 27th September - 10am - 3pm
Week 2
Days & Times Requesting :
Tuesday 1st October - 10am - 3pm
Wednesday 2nd October - 10am - 3pm
Thursday 3rd October - 10am - 3pm
Friday 4th 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
