Expression of Interest - School Age Holiday Group - Autism Association of Western Australia

Group Selection

Please select which Holiday Group you are interested in:*

Which is your preferred location?*

Parent/Carer Name*

First Last

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

Contact number*

What is your child's name?*

First Last

What suburb does your child live in?*

Is your child currently accessing Autism Association School Age Therapy Services?*

If yes, please let us know your child's Therapist's name*

Has your child previously attended School Age Holiday Group? (tick all that apply)*

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

Which school year will your child be in in 2022?*

What School Support Setting best describes your child’s situation?*

Other - please describe:*

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