Events Intake Form — A Better Tomorrow Australia

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Events Intake Form

Getting Started

ABTA Intake Form

Events Intake Form

Getting Started

ABTA Intake Form

Folder: About Us

Events Intake Form

Getting Started

ABTA Intake Form

Intake Form

Interested in coming to a workshop? Fill out our enrolment form below.

Client Details *

First Name

Last Name

NDIS Number *

DOB

MM

DD

YYYY

Email *

Phone

(###)

###

####

What workshop are you interested in? *

Fishing

Mosaics

Social Art

Gel Blasting

Plant Series

Life Skills

Boxing/Fitness

Dungeons and Dragons

Other

Date I would first like to attend: *

MM

DD

YYYY

Support Person Details: (if one attending)

Emergency Contact Details:

Invoicing Information: *

Where would you like your invoices to be sent?

Phone *

(###)

###

####

Email *

Plan Manager

Phone *

(###)

###

####

Email *

Medical Information *

Privacy Statement A Better Tomorrow Australia is collecting this medical information in order to address the medical needs during the workshop. For example. Diagnosis, Medical Management, Triggers, Allergies, Dietary Preferences etc. Anything relevant that we may need to know. Known Medical Conditions?

Yes

No

Medical Conditions (including allergies/sensitivities):

I consent to A Better Tomorrow Australia to taking photos and/or videos of me and my art for marketing purposes.

Yes

No

I, *

confirm all client details above to be correct and agree to receiving a service agreement from A Better Tomorrow Australia. *

Person acting on behalf:

Please fill out if you are acting on behalf of someone

Thank you!

We acknowledge the Traditional Owners and Custodians of the lands on which we live and work, and pay our respect to Elders past and present.

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