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Home
About
Programs
School Term
Breakout Program
Sunday Sessions
Play Tech Nights
Forms
Enrolment Form
Mentor Application
Gallery
News
Contact
Play Tech Sunday Sessions
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PARTICIPATION AGREEMENT
Play Tech Australia is a Social Tech Club for young Autistic and Neurodiverse people aged 9 to 20 years to develop their social skills while engaging with technology. The groups primary focus is the social connections and interactions.
Which program would you like to enrol in?
*
Play Tech Sunday Sessions
Sessions
*
6th October - Revolution Sports & Transformers One Movie - 9.30am - 4.30pm - $630
27th October - Aussie World - 9.30am - 4.30pm - $630
3rd November - Fishing Day - 9.30am - 4.30pm - $630
17th November - Sealife & Amaze World 9.30am - 4.30pm - $630
1st December - Holey Moley/Hijinx Hotel/Arcade - 9.30am - 4.30pm - $630
Invoicing will be weekly for the entire term.
PARTICIPANT PERSONAL DETAILS
Student Name
*
First
Last
Preferred Name
Sex
*
Select...
Male
Female
Non-Binary
Undisclosed
Birth Date
*
DD slash MM slash YYYY
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
CARER DETAILS - PRIMARY
Have you already provided Carer details?
*
No
Not Sure/Need to update Details
Carer's Name
*
First
Last
Contact Mobile
*
Email Address
*
CARER DETAILS - SECONDARY
Second Carer's Name
First
Last
Contact Mobile
Email Address
EMERGENCY CONTACTS
Have you already provided Emergency Contact details?
*
No
Not Sure/Need to update Details
Please complete up to 2 emergency contacts
*
Name
Relationship
Contact Number
PARTICIPANT MEDICAL DETAILS
Have you already provided Medical details?
*
No
Not Sure/Need to update Details
Does the student have any of the following impairments?
(Tick all that apply)
Hearing
Speech
Vision
Mobility
Does the student have a diagnosis?
*
Yes
No
Please specify:
*
Does the student suffer from Asthma?
*
Yes
No
If my child displays any symptoms of asthma, please:
Contact Parent/Carer
Call Emergency Services
Other Medical action
Please specify:
Safety is our priority, but in the unlikely event of an accident involving your child, do you consent to first aid being administered?
*
(Eg. CPR, Band-Aids, etc.)
Yes
No
Do you consent to medical treatment in the form of ambulance attendance and treatment if deemed necessary?
*
Yes
No
Does the student have any allergies?
*
Yes
No
Please specify:
*
Does the student have any dietary requirements?
*
Yes
No
Please specify:
*
Does the student have any other medical condition?
*
Yes
No
Please specify:
*
NDIS DETAILS
Have you already provided NDIS details?
*
No
Not Sure/Need to update Details
Does the student have NDIS?
*
Yes
No
NDIS Number:
Access Type:
*
Self-Managed
NDIA Managed
Plan Managed
Plan Manager Name
*
Plan Manager Email
*
Funding Options:
*
Core Supports CB01 – STA And Assistance (Inc. Respite)
Core Supports CB04 – Access Community, Social And Rec Activities
Self- Funded
Not Sure
SOCIAL MEDIA RELEASE
Do you consent to photographs of your child being used for advertising purposes eg. on website, brochures, banner etc?
*
Yes
No
TERMS & CONDITIONS
Play Tech Australia provides a venue where young people can explore their own technology interests at their own pace in a safe social environment, with support from professional mentors. The sessions encourage social participation and community engagement.
For NDIS participants the supply of this service is one or more of the reasonable and necessary supports specified under subsection 33(2) of the NDIS Act, in the participant’s NDIS plan.
It is the responsibility of the parent/carer to sign in/out their child for each session. This help with our COVID safe plan.
There will be some shared equipment to use if needed. Participants can bring their own laptops and/or ipads. However, we do not take responsibility if they are lost, stolen or damaged.
Violence will not be tolerated and should the participant verbally or physically threaten the mentors or other participants, they will be removed and asked to leave.
Non-Face-to-Face (NF2F) fees that reflect the cost of meeting the individual participant’s needs for a group-based support. Included in the price above is 15 mins NF2F per session and signing this agreement you acknowledge this charge. (included in price)
Cancellations of Service Sunday Program
- The notice period for a holiday session is seven (7) clear days’ notice. If services are cancelled without seven days notice, 100% of the agreed price will be charged.
Informed Consent
By your participation you accept the inherent risks of possible injury or harm associated with the activities and travel to activities, and release, absolve and hold harmless Play Tech Australia and all its respective officers, agents, and representatives from any and all liability for injuries to said adult arising out of traveling to, participating in, or returning from selected sessions.
In case of injury to said person, you hereby waive and/or release Play Tech Australia, to the full extent permitted by law, from all liability in respect of any claim for personal injury or death, for a failure to comply with any express or implied warranty or guarantee that the services will be provided with reasonable care and skill.
Medical Release
In the event of a medical emergency, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the participant’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is also granted to the Play Tech Australia. and its affiliates including Directors, Coaches, and Support Workers to provide the needed emergency treatment prior to the adult’s admission to the medical facility.
Thank you for taking the time to complete this Student Enrolment form. We understand that the information you have provided is confidential and will be treated as such, but the details are required to enable staff to properly enrol your child at Play Tech Australia.
Consent
*
I agree to the Terms & Conditions
Date
MM slash DD slash YYYY
Signature
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