RLCG Singing Group EOI

Sing Loud, Shine Bright! Where Music, Friendship, and Confidence Come Together.

Name Of Person Filling Out Form *

Relation to Participant: *

First Name *

Last Name *

I would like to attend *

Individually (with a support worker to myself)At a 1:3 Ratio (with a support worker to assist and support myself and 2 others)

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.

Please Specify *

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