RLCG Term 3 2026 Groups Referral Form

Our 10 Week Program for term 3, 2026 will be running
20/07/2026 - 25/09/2026

Referrer Details

Referrer Name *

Relationship to the person being referred

Phone Number

Email Address

Are you an Existing RLCG Participant *

YesNo

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? *

RLCG 4 Kids (Mondays) (2:45PM - 5:15PM)Crafternoon Tea, (Tuesdays) (1:00PM-4:00PM)Hobby shop (Tuesdays) (11:00AM - 2:00PM)Teens D&D (Ages 12-17) (Tuesdays) (4:00PM - 7:00PM)Dungeons and Dragons, (ages 18+) (Various Days) (3:00PM - 8:00PM)Whale Watching, (ages 18+) (Various Days) (3:00PM - 8:00PM)Photography, (Fridays) (9:00AM - 1:00PM)Band (Fridays) (2:00PM - 5:00PM)

Each group program will run for 10 weeks from 21/07/2026 - 25/09/2026

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

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

Support CoordinatorPlease include name, contact number and email if possible