Participation Registration Form Please fill out below “Participation Registration Form”. If you have any questions, please get in touch. First Name *Last NameParticipant (D.O.B) * *Participant NDIS number * *How is the participants funds managed? *Self managedPlan managedAgency managedNot on the NDISIf the participant is plan managed who is the plan manager? If you know the invoice email, please provide that. If not plan managed please leave blank. Please include plan manager invoices email if you know it.Plan NomineeParticipants &/or plan nominee contact phone number *Participants or plan nominee contact email *Current NDIS plan start dateCurrent NDIS plan end dateStreet Address *Suburb *StatePost CodeParticipant available days * *MondayTuesdayWednesdayThursdayFridaySaturdaySundayAvailable Timings *Participant conditions *Please mention any challenging behaviours or cultural values that would help us provide services e.g Allergies, violent outbursts, triggers, risks if any etc. *Can the participant be dropped to a centre if required?YesNoSometimesDo you have space in your home to do Yoga?YesNoMay beDo you have any culture values or beliefs that would help us provide our services? SUBMIT THE FORM
