(08) 9431 2111
Find Us
Search Icon
About Us
Our Organisation
Our People
Our Ambassadors
Our Policies
Research
Testimonials
Services
Social Groups
Education & Training
Life Skills
Symposium
What’s On
Spectrum Space Symposium 2023
Gibb River Road Challenge 2023
Telethon Holiday Makers Program
Autism Identity & Awareness for Neurodivergent Adults
Autism Awareness for Families
Let’s Get Working
Past Events
Get Involved
Youth Council
Job Vacancies
Volunteer, Internships & Work Placements
Partnerships
Donate & Support
Fundraising
Resources
NDIS
FAQs
News & Updates
Contact Us
Donate
Search Icon
Telethon Holiday Makers Expressions of Interest – Fremantle
Home
/
Social Groups
/
Telethon Holiday Makers Program – 5-18 years
/
Telethon Holiday Makers Expressions of Interest
/
Telethon Holiday Makers Expressions of Interest – Fremantle
Click here to return to previous page.
Fremantle Holiday Expression of Interest Form
Section 1 – Participant's Details
Name
*
First
Last
Date of Birth
*
DD slash MM slash YYYY
Does the participant have any of the below cards? If so please bring these for each day attending
*
Please tick all that apply.
Companion Card
Concession Card
Student Card
SmartRider Card
None of the above
If participant does not have a SmartRider, exact change for public transport will be required.
Age of Participant
*
15-18 years
10-15 years
5-10 years
Unfortunately we have reached full capacity for both the 5-10 days. Please try again next school holidays.
Has the participant attended a social support group at Spectrum Space?
*
Either in the past or current.
Yes
No
Which social group do/have they attend/ed?
In what year did the participant last attend the above group?
Section 2 – Session Details
This section will appear when you select the Age of Participant above. Any days that are already full will be removed from view.
Mon – July 3rd
10-15 years
9.30am-4.30pm – Sushi Making, Werewolf Card Game & Rock Climbing ($25 extra will be invoiced)
Tues – July 4th
10-15 years
9.30am-4.30pm – Card Games & His Majesty’s Theatre ($20 extra will be invoiced)
Wed – July 5th
10-15 years
9.30am-4.30pm – Marble Run Challenge & WA Maritime Museum ($10 extra will be invoiced)
Thurs – July 6th
15-18 years
9.30am-4.30pm – Pillow Case Making & Virtual Reality @ Glowing Rooms ($48 extra will be invoiced)
Fri – July 7th
5-10 years
9.30am-12.30pm – NAIDOC Key Ring, Super Spy Lazer Maze & Party Games
Mon – July 10th
10-15 years
9.30am-4.30pm – Pancake Making, Real-Life Among Us & Nostalgia Box ($14 extra will be invoiced)
Tues – July 11th
10-15 years
9.30am-4.30pm – Pillow Case Making & Indoor Volleyball ($5 extra will be invoiced)
Wed – July 12th
10-15 years
9.30am-4.30pm – Cicerello’s & WA Shipwreck Museum ($17 extra will be invoiced)
Thurs – July 13th
15-18 years
9.30am-4.30pm – Video Game Arcade @ Escape Portal ($13 extra will be invoiced)
Fri – July 14th
5-10 years
9.30am-12.30pm – Yoga, Science Experiment & Party Games
Hidden
Mon – January 23rd
10-15 years
9.30am-4.30pm – Swimming & Driftwood Wall Art ($5.50 extra will be invoiced)
Hidden
Tues – January 24th
15-18 years
9.30am-4.30pm – Crafts & Beyond Skates ($15 extra will be invoiced)
Hidden
Wed – January 25th
10-15 years
9.30am-4.30pm – Art Journaling & Beyond Skates ($15 extra will be invoiced)
Hidden
Thurs – January 26th
15-18 years
9.30am-4.30pm – Crafts Karaoke Movie
Hidden
Fri – January 27th
5-10 years
9.30am-12.30pm – Murder in the Dark, Build a Bridge, Sock War & Flying Carpet
Section 3 – Funding
NOTE: You can use your NDIS funding to access our services.
Funding
*
Self Funded (all program sessions are paid by you with no reimbursement from any external body)
Funded (Program sessions are partially or fully funded by an external body such as NDIS, CRCC or similar)
NDIS Funding
*
Do you have NDIS funding?
Yes
No
Hidden
How is your NDIS Plan managed?
*
Self Managed
NDIS Managed
Agent Managed
How is your NDIS Plan managed?
*
You can utilise your Social and Community Participation NDIS funding for service if you’re Self or Plan Managed, but not if you are NDIA Managed. If you would like to discuss your options please contact enrolments@spectrumspace.org.au or call our office on 08 9431 2111.
Self Managed
Plan Managed
Name of Funding Organisation
Section 4 – Contact Details
Name
*
Prefix
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Contact Number
*
Email
*
How did you hear about us?
*
Please select one of the following
Search Engine (Google, Yahoo, Bing, etc)
Friend
Social Media (Facebook, Twitter, LinkedIn, Instagram, etc)
Other Provider
Allied Health Professional
Other
If Other, please specify
*
ALERT
It appears you have not selected which days you would like to attend,
please go back to Section 2 before you submit the form.
Name
This field is for validation purposes and should be left unchanged.
Δ