Master Kitchen - Therapy Groups for Adults - Autism Association of Western Australia

Would you like to join a Master Kitchen Group?

Master Kitchen (Adults) EOI

Name*

First Last

Participants Date of Birth*

Date Month Year

Email (this will be our primary method of contacting you)

Contact number*

Please choose which location you would prefer: (choose 1 )*

Are you currently receiving therapy services through the Autism Association?*

If yes, please let us know your Key Therapist's name:

Do you have access to therapy funding? (tick all that apply)

Contact person for participant (if required):

Name: Phone: Email: