GC Bowling & Social Group

Booking Form

First name*

Last name*

Email*

Phone*

Birthday*

Day

Month

Year

Address*

NDIS Number:*

Diagnoses

Funding Management*

Plan Managed

Self Managed

Email for invoicing:*

Support Coordinator (if applicable):

🚌 Transport Options:*

I will arrange my own transport to and from the Hub in Nerang

I require drop-off and/or pick-up (additional charge applies, a quote will be provided)

Address for pick-up/drop-off if required:

🥗Lunch is included with this group. Please provide information relating to any food allergies or aversions:

🔉Please list any sensory sensitivities, regulation tools, or strategies that help:

Emergency Contact 1:

Emergency Contact 2:

Attendance: *

Attendance*

I would like to attend every Sunday

I would like to attend Fortnightly or Monthly

I would like to attend as a once off

✅ Authorisations

I consent to participation in the Sunday Bowling Social Group

I understand that $40.86/hr will be charged from Core Supports (1:3 ratio)

I understand that if I require transport to and from the Hub, I will be provided a quote for extra supports and travel

I understand that I will be provided a Service Agreement for the supports listed above

Contact us!

Name

Phone

Email

Message

Thanks for submitting!

Locations

Gold Coast Hub: 2/9-11 Price Street, Nerang QLD 4211

Sunshine Coast Hub: 21a Allen Street, Moffat Beach QLD 4551

Brisbane & Mackay:

Phone

Gold Coast: 0424 167 936 (Carli)

Sunshine Coast: 0451 833 614 (Angela)

Brisbane & Mackay: 0421 223 882 (Aaron)

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