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Register – Physical Recreation Group

Register – Physical Recreation Group

This group is aimed towards Rocky Bay customers seeking a physical activity.

Are you a current customer of Rocky Bay's Community Division?*
- Yes
- No
It is a requirement of this group that participants attend with a Rocky Bay support worker.
Your full name*
First Last
Date of birth*
MM slash DD slash YYYY
Carer's name*
First Last
Carer's Phone*
Suburb*
Your suburb
Your best email*
Your best phone number*
Preferred contact method
What does the participant hope to achieve from the group?*
Is there a goal in the participants NDIS plan that relates to social and community participation and/or health and wellbeing?*
- Yes
- No
- N/A
Is the participant ok to take part in physical activities that involve the arms and legs?*
- Yes both
- No both
- Arms only
- Legs only
Is the participant comfortable in a group environment interacting with others?*
- Yes
- No
Is the participant happy to follow 3-step instructions?*
- Yes
- No
E.g. Hit the ball, run to the cone and then do 5 star jums
Does the participant have a tendency to become aggressive, anxious or run away?*
- Yes
- No
Where did you hear about this event?
- Rocky Bay Staff Member - Community
- Rocky Bay Staff Member - Other
- Poster
- Social media e.g. Facebook
- Website
- Other
Are you happy to have your photo taken for marketing purposes?*
- Yes
- No
Would you like to keep up to date with Rocky Bay news?*
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

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60 McCabe Street,
Mosman Park, WA 6012

Phone (08) 6282 1900

ABN 66 028 387 386
ACN 636 892 898

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NDIS PROVIDER NUMBER
4050002098

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Rocky Bay acknowledges the traditional owners of country throughout Australia and their continuing connection to land and community. We pay our respect to them and their cultures, and to elders past and present.

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