January 2022 School Holidays Intensives

IMPORTANT INFORMATION

We only have a limited number of guaranteed places. If you miss out on one of our guaranteed spots, you will be placed on the wait list & contacted should we receive any cancellations.

Child's Name *

Parent's Name *

Email Address (this is the email address where your intensive schedule will be sent to) *

Address *

Suburb *

State *

Postcode *

Phone *

Child's Date of Birth * +

Does your child have a diagnosis and if so please specify (This information will help with the scheduling process) *

Current Medications (If any) *

Gender *

Male

Female

Are you using NDIS Funding? *

Please upload your child's current NDIS plan (if applicable) ** For ALL NDIS clients - We require a minimum of your child's NDIS goals, NDIS participant Number & Plan dates, plus if you are agency, plan or self managed. This is what is required for NDIS auditing purposes **

Has your child been to The Sensory Gym before? *

Yes - Last seen prior to January 1st 2021 - We will require you to supply some updated information (Please upload your completed Previous Client Questionnaire, Risk Management Form & any current reports from other therapists below. If you haven't yet completed these forms, please click on the links below and then upload once completed).

Yes - Last seen after January 1st 2021 - You do not have to complete the OT questionnaires - Just the Risk Management Form. Please upload it along with any current reports from other therapists.

No (New Client) - You will be required to supply further information (Please upload your completed Referral Questionnaire, Sensory History Form, Pre/School Questionnaire, Risk Management Form and any current reports from other therapists below. If you haven't yet completed these forms, please click on the links below and then upload once completed).

DOWNLOAD QUESTIONNAIRES & RISK FORM HERE:

Please complete & upload the Risk Management Form from our website. ALL CLIENTS MUST COMPLETE THIS FORM. *

Please upload the Referral Questionnaire If you have never been to The Sensory Gym®. FOR ALL PREVIOUS CLIENTS PLEASE COMPLETE THE PREVIOUS CLIENT FORM (FOUND ON OUR WEBSITE). *

Upload Sensory History Form Here: ALL NEW CLIENTS TO COMPLETE.

Upload Preschool or school questionnaire here: FOR NEW CLIENTS ONLY.

Other document uploads here: i.e Therapy Reports, etc.

Please upload a recent photo of your child. This will be stored in your child's file. *

Scheduling Your Intensive Program

Intensive Scheduling

Please note that we schedule each intensive program based on the order in which it is received.

Requesting a Therapist or Particular Time:

Please note that when requesting a particular Therapist or time for your intensive program, we CANNOT GUARANTEE this to you. We always try our very best to accommodate everybodies needs but at times your requests cannot be met.

Intensive Deposits:

Please note that when booking your intensive program you will be prompted to enter your card details for the $50 holding deposit. Please note that your card will NOT be debited unless the cancellation fee applies. All credit card details are stored on our secured site.

Intensive Waitlist:

Please note that we only have a set number of guarenteed spots for each intensive program. For anyone who misses out on a guaranteed intensive spot they will be placed onto our wait list.

Selecting Your Intensive

The intensive dates in which I am applying for: *

January 2022 Intensive Week 1:

January 2022 Intensive Week 2:

January 2022 Intensive Week 3:

January 2022 Intensive: Any Week

If your Therapist preference is not available will you still attend if we schedule your child with a different Therapist? *

Is there anything else we should know regarding your request? Please remember that we always try our best to accommodate each families requests but unfortunately it is not always possible.

HOLDING DEPOSIT

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Please note that your credit card details will be stored on our secure site. Your card will NOT be debited unless the cancellation policy applies.

Receiving My Schedule & Cancellation Policy

Your intensive schedule will be emailed to you in the month or so leading up to the intensive. If there is a change in your circumstances, or if you have decided that you no longer wish to attend the intensive program, please contact our office immediately to advise.

We do have a cancellation policy and failure to notify The Sensory Gym of your cancellation may result in fees being charged.

Cancellation Policy

Cancellations that occur less than 20 business days before your intensive will result in a cancellation fee of $50, unless the intensive spot is able to be filled.

Cancellations that occur less than 10 business days before your intensive will result in a cancellation fee of 50% of the entire intensive fee, unless the intensive spot is able to be filled.

Cancellations that occur less than 5 business days before your intensive will result in a cancellation fee of 100% of the entire intensive fee, unless the intensive spot is able to be filled.

This includes all NDIS & Non NDIS clients.

I agree that I have read and understood the terms of the above cancellation policy: *

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