Real Life Community Group

Bike riding group. Expression of Interest

Get on your bikes & ride! A social and community group to get your push bikes or mountain bikes down to Cringila Hills Mountain Bike Park! All ages and abilities welcome!

Name Of Person Filling Out Form *

Relation to Participant: *

First Name *

Last Name *

I would like to attend *

I'm going to bring myself (no supports needed)Individually (with a support worker to myself)At a 1:3 Ratio (with a support worker to assist and support myself and 2 others)I am not interested in this group

We recommend individual supports for anyone under 18, anyone that may require assistance with feeding, toileting, medication, or anyone who does not wish to attend for the whole evening.

What day works best for you

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Tick all days that work for you

My Support Facilitator is: *

Amy KominkovskiDylan KlohkMacey CerasaniMitchell SmithRenee JolleyScott Brancourt/ Tristan AgostiniNicole CampbellAedan ChaselingMichael OxfordI'm not an RLCG participant

Comments

Participant Details

Full Name

NDIS Number *

Date of Birth *

Best contact *

Address

Emergency Contact *

How is your plan managed *

Self Managed Plan Managed Agency Managed

Plan Manger Details *Please include name, contact number & email.

Support CoordinatorName, contact number & email

Plan Start Date

Plan End Date

Having difficulty completing this form? If so, please contact Michael on 0499 981 728 or email fun@rlcg.org.au

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