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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
SUMMER SCHOOL HOLIDAYS 2025
Week 1
Days & Times Requesting :
Tuesday 7th January - 10am - 3pm
Wednesday 8th January - 10am - 3pm
Thursday 9th January - 10am - 3pm
Friday 10th January - 10am - 3pm
Week 2
Days and Times Requesting :
Tuesday 14th January - 10am - 3pm
Wednesday 15th January - 10am - 3pm
Thursday 16th January - 10am - 3pm
Friday 17th January - 10am - 3pm
Week 3
Days and Times Requesting :
Tuesday 21st January - 10am - 3pm
Wednesday 22nd January - 10am - 3pm
Thursday 23rd January - 10am - 3pm
Friday 24th January - 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