Referral Form

Thank you for your interest in our Sensory Play Centre. Please complete the following registration form to help us understand your child’s needs and preferences. Our team will contact you after you submit the form.

Please note that we respect your privacy. All information provided will remain confidential and will only be used to support your child’s participation and experience at the Sensory Play Centre.

To select your preferred schedule, please download the schedule by clicking the download button. Complete the schedule and upload it in the form below.

Participant Information

Full Name

Gender

Phone

Participant NDIS number

NDIS funding type

NDIS Plan Start Date

NDIS Plan End Date

Primary Diagnosis

Primary Contact (if different from participant)

Full Name

Relationship to Participant:

Contact Number

Email Address:

Address Details

Street Address

Suburb/City:

Postcode

State

Support Services Requested: (Please check all that apply)

Support Services Requested

Open Play (Unsupervised)

Private Hire

School Holiday Program

Support to Access the Community / Social Participation

Specialised Support Coordination

Respite Care (Short Term / Medium Term / Long Term)

Early Childhood Intervention Support

Upload Participant's NDIS Plan

Max. file size: 1 GB.

Additional Information

Please provide any relevant details about the participant's needs, preferences, and NDIS goals that will help us better understand how to tailor our services to their requirements.

Additional Information

Referrer Information (if applicable):

Referrer's Full Name:

Organization (if applicable):

Contact Number:

Email Address:

Plan Manager's Details (if applicable)

Name

Phone

Address

Declaration

I confirm that I have obtained consent from the participant (or their legal guardian) to submit this referral form and share the provided information for the purpose of accessing NDIS participant support services.

Participant/Guardian Signature:

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Book Your Session Today!

We can’t wait to welcome your child to Sensory Play Centre—where every child can play, learn, and thrive in a space designed just for them!

Referral Form

Participant Information

Primary Contact (if different from participant)

Address Details

Support Services Requested: (Please check all that apply)

Upload Participant's NDIS Plan

Additional Information

Referrer Information (if applicable):

Plan Manager's Details (if applicable)

Declaration

Book Your Session Today!

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