Register | Strong + Courageous

Child's information
Child's first name*
Child's Surname*
Preferred name*
Date of Birth*
Gender*
Height*
Weight*
Diagnosis*
T-shirt size*
Shoe size*

Funding information

What funding will you be accessing?*

NDIS Self-managed

NDIS plan managed

Self-funded

NDIS Participant number

NDIS plan end date

Name of plan manager

I confirm that current NDIS plan dates cover the the proposed intensive dates *

Yes

No

I confirm that there are sufficient funds in NDIS plan to cover this intensive*

Yes

No

NDIS Plan

Access to your NDIS Plan

This is really important to help us give you the right guidance by understanding your plan dates, goals and what is and is not included in your plan. It also helps us to provide you with accurate advice around booking appointments, using your budget well, and determining whether additional reports would help advocate for your child. To maintain your privacy, we do not need to see your budget amounts so these figures can be removed prior to sharing.

There are a couple of ways to share this document with us:

1. Attached a copy of your NDIS plan
2. You can also find your plan in the my NDIS portal and the my NDIS app. You can email this to us as a PDF.
3. You can provide consent to us to be emailed a copy from the NDIS or partner office (your local ECEI partner) and you can ask them to share all or part of the plan with us

For your peace of mind, we will not share your personal information with anyone else without your permission, and comply with the Privacy Act 1988.
How will you share your NDIS plan with us?*

I'll attach my NDIS plan now

I will email my NDIS plan directly to info@strongandcourageous.com.au

I will request the NDIS/my local ECEI partner to share all or part of the plan with you by email

Upload your NDIS plan here:

Drop files here or

Max. file size: 128 MB.

Great. Please direct emails to info@strongandcourageous.com.au

Photo/video consent

I allow Strong and Courageous to take photos of my child during sessions. By ticking yes, I give Strong and Courageous the right and permission to use and publish the photographs/film/video tapes/electronic representations and/or sound recordings made of us, and I hereby release Strong and Courageous from any and all liability from such use and publication. I hereby authorise the reproduction, sale, copyright, exhibit, broadcast, electronic storage and/or distribution of said photographs/ film/video tapes/electronic representations and/or sound recordings without limitation across all media and in perpetuity at the discretion of Strong and Courageous and I specifically waive any right to any compensation I may have.
Photo/video consent*

Yes

No

Enter your full name below to signify the information provided is accurate and up to date. This will be use in lieu of a written signature.
Your full name*

Today's date*

Would you like to signup to our newsletter?*

Yes please

No thanks

Email
This field is for validation purposes and should be left unchanged.

Register Now

In order to get started with S+C, we’ll need you to fill out the registration form below.
Please note, you must complete a free consultation before starting the program.
If you’d like more information on our process, you can see that here.

Looking to book follow up sessions? You can go straight to our booking calendar here.

In order to get started with S+C, we’ll need you to fill out the registration form below. Please note, you must complete a free consultation before starting the program. If you’d like more information on our process, you can see that here.

Step 1 of 8

Child's information

Family information

Home Address

Contact Details

Your child's strengths and interests

BOOSTA+ Intensive Planning

Other Therapy Options

Medical information

Other Therapy Providers

Funding information

NDIS Plan

Photo/video consent

Name of therapist	Clinic	Frequency