HomeRegister – Gaming Group Register – Gaming Group Step 1 of 5 20% Select a session*PKC Cockburn - 27 September to 7 October - 9am to 11amMandurah - 27 September to 7 October - 9am to 11amPKC Cockburn - 27 September to 7 October - 12:30pm to 2:30pmExpression of interestDo you have the Bedrock edition of Minecraft? Yes No Unsure If you answer No or Unsure, a therapist will contact you to discuss your registration. Due to the use of a Minecraft server, you will need to already own the Bedrock edition of Minecraft (not the Java edition). 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Yes No Prefer not to say Do you have any religious or cultural needs?* Yes No If yes, please comment* Do you have any Guardianship or Financial Administration Orders in place?* Yes No If yes, please comment* Are there any other health issues or allergies we need to be aware of?* Yes No If yes, please comment* Diagnosis* What does your child hope to gain from this group?What funding do you receive?* NDIS - Funds allocated to Rocky Bay NDIS - Other WANDIS Block Funding Medicare Referral Privately Funded Unsure If NDIS Other, how is your plan managed:* Self-Managed Plan Managed What is your plan manager's email?* What is your NDIS number? Plan start and end date: Do you currently receive services from a Rocky Bay Therapist?* Yes No Did your therapist refer you to this group?* Yes No Which Rocky Bay therapist referred you to this group? Is your child aged between 10 - 17 years?* Yes No Is a goal relating to social interactions, making friends, flexible thinking and/or self-regulation covered in your child's plan?* Yes No Unsure Comment* Does your child have emerging skills in understanding the thoughts and feelings of themselves and others?* Yes No Unsure Comment* Is your child able to communicate their thoughts and wants to others within stressful situations?* Yes No Unsure Comment Can your child work within a group environment?* Yes No Unsure Comment* Does your child behave in a safe manner towards others in a group setting within stressful or frustrating situations?* Yes No Unsure E.g. Character dying within a Minecraft game. Comment* Do you (or anyone else) support your child to regulate their emotions within stressful or frustrating situations?* Yes No Unsure E.g. Character dying within a Minecraft game. Comment* Does your child have a behaviour support plan?* Yes No Unsure If yes, can our facilitators have access to the plan?* Yes No Does your child have a tendency to become aggressive, anxious or run away?*If yes, please provide details of any strategies you have in place to manage/reduce these tendencies. Does your child require any support with communication?* Yes No What type of device does your child have? Please confirm that you are able to attend all sessions* Yes No Unsure Comment* Is there anything else we need to know before attending the group?*Where did you hear about Gaming GroupEmail - Rocky BayEmail - OtherKalparrinFacebookGoogle SearchTherapistRocky Bay websiteWord of mouthOtherWould you like to keep up to date with Rocky Bay news?* Yes No NameThis field is for validation purposes and should be left unchanged. Δ
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