RLCG 2026 Summer Groups Referral Form

Referrer Details

Referrer Name *

Relationship to the person being referred

Phone Number

Email Address

Participant Details

Full Name *

NDIS Number *

Date of Birth *

Email Address

Address *

Emergency Contact InformationPlease include name, phone number and relationship if possible

What groups is the participant interested in? *

Kids Club Monday 2:45PM - 5:45PMUnder 18's Only Monday 3:00pm - 6:00PMKids Club Friday 2:45PM - 5:45PMUnder 18's Only Friday 3:00pm - 6:00PMCrafternoon Tea Monday 11:00PM - 2:00PMCrafternoon Tea Tuesday 11:00PM - 2:00PMDungeons & Dragons Wednesday 3:00PM - 8:00PMDungeons & Dragons Thursday 3:00PM - 8:00PMSocial Group Thursday 4:00PM - 8:00PMPhotography Monday 9:00AM - 1:00PMPhotography Friday 9:00AM - 1:00PMLego Lunch Wednesday 11:00AM - 2:00PM

Each group program will run for 4 weeks from January 5th to January 30th

Is a group that you are interesting in attending missing?

Do you have a suggestion for us to improve our service to you?

Please let us know!

Click here to give us Feedback

Plan Details

How is the plan managed? *

Self-ManagedPlan ManagedAgency Managed

Plan Manager Information *Please include name, contact number and email if possible

Plan Start Date

Plan End Date

Hours of SupportHow many hours of support do you wish to receive over the duration of the Schedule of Supports?

RLCG Support FacilitatorOptional; please answer if you are already receiving supports from RLCG

Support CoordinatorPlease include name, contact number and email if possible

Please wait, files are uploading..