Holiday Group Sign-Up & Consent Form

Please select the relevant consent form for your child's upcoming Community Coins Session *

Is you child a current or past member of the Brick Club program at Therapy Matters?

Yes No

The group program you have selected is reserved for past or present member of the Brick Club Group at Therapy Matters. Please select one of the other holiday group experiences for your child.

Purpose

This experience is designed to meet goals in the following areas:

Being social in the community
Connecting with like-minded peers
Navigation and problem solving skills
Develop independence
Conversing and communicating in a group setting
Build friendships and connect with like-minded peers
Develop teamwork & negotiation skills
Embrace strengths and self-advocacy skills.

This experience is designed to meet goals in the following areas:

Foster connection with brick club friends in a less-structured setting
Being social in the community
Connecting with like-minded peers
Navigation and problem solving skills
Develop independence
Conversing and communicating in a group setting
Build friendships and connect with like-minded peers
Develop teamwork & negotiation skills
Embrace strengths and self-advocacy skills.

Holiday Group Experience Details

WHAT: Easter Fun!

WHEN: Monday 7th of April 9am-4pm

WHO: Your child, 3-5 peers and 2-3 therapy assistants

WHERE: Therapy Matters

HOW MUCH: $444.06 - $545.32 (depending on group numbers)*

WHAT TO BRING:

Small bag or backpack with morning tea, lunch & drink bottle
Comfortable walking shoes
Hat

* Therapy Matters standard cancellation policies apply (for less than 2 clear business days notice)

WHAT : Bounce Fun!

WHEN: Tuesday 15th of April 9am-4pm

WHO: Your child, 3-5 peers and 2-3 therapy assistants

WHERE: Travel by bus/coach to Bounce Burleigh and return to Therapy Matters for afternoon activities

HOW MUCH: $444.06 - $545.32 (depending on group numbers)*

WHAT TO BRING:

Small bag or backpack with morning tea, lunch & drink bottle (please make sure your child can carry all their things)
Comfortable walking shoes
Hat

* Therapy Matters standard cancellation policies apply (for less than 2 clear business days notice)

WHAT: Brick and Bounce

WHEN: Wednesday 9th of April 9am-4pm

WHO: Your child, 2-4 brick club peers, Tania (Speech Pathologist) and Mariana (Therapy Assistant)

WHERE: Bounce Burleigh and Therapy Matters

HOW MUCH: $533.12 - $795.01 (depending on group numbers)*

WHAT TO BRING :

Small bag or backpack with morning tea, lunch & drink bottle (please make sure your child can carry all their things)
Comfortable walking shoes
Hat

* Therapy Matters standard cancellation policies apply (for less than 2 clear business days notice)

WHAT: Hoopla and Brick Club!

WHEN: Wednesday 23rd of April 9am-4pm

WHO: Your child, peers, Tania (Speech Pathologist), Sarah (Speech Pathologist) and Lillie (Therapy Assistant)

WHERE: Hoopla Circus and Therapy Matters Murwillumbah

HOW MUCH: $533.12 - $795.01 (depending on group numbers)*

WHAT TO BRING :

Small bag or backpack with morning tea, lunch & drink bottle (please make sure your child can carry all their things)
Comfortable walking shoes
Hat

* Therapy Matters standard cancellation policies apply (for less than 2 clear business days notice)

Timetable

Bounce Fun! Timetable

9.00 – 9.15 Therapy Matters Arrival and Greeting in Suite 3 Downstairs

9.15-10.15 Getting to know each other/Morning Tea

10.00 – 10.15 Walk to Bus Stop

10.30 – 10.45 Bus to Stocklands

10.45 – 11.00 Walk to Bounce

11.00 – 1pm Bounce

1 - 1.15 Take the Koala Coach back to Therapy Matters

1.15 – 1.45 Lunch/You Tube at Therapy Matters

1.45 – 3.45 Activities in clinic (Options for lego, craft, board games, gaming)

3.45 - 4.00 Therapy Matters Pick up

Easter Fun! Timetable

9.00 - 9.15 Drop Off at Schuster's Park

9.15 - 10:30 Easter Activities including an Easter egg hunt!

10:30-11 Walk back to Therapy Matters

11-12 Easter activities

12.00 - 2.00 Lunch and Easter Movie

2.00 - 3.00 Easter Activities

3.00 - 4.00 Activities in clinic (Options for lego, craft, board games, gaming)

3.45 – 4.00 Therapy Matters Pick up

Bounce and Brick! Timetable

9.00 – 9.15 Therapy Matters Arrival and Greeting in Suite 3 Downstairs

9.15-10.15 Getting to know each other/Morning Tea

10.00– 10.15Walk to Bus Stop

10.30– 10.45 Bus to Stocklands

10.45– 11.00 Walk to Bounce

11.00– 1pm Bounce

1 - 1.15 Take the Koala Coach back to Therapy Matters

1.15 – 1.45 Lunch/YouTube Share at Therapy Matters

1.45 - 3.45 Brick Club Hangout including Creative Builds + Movement games & Youtube shares

3.45 - 4.00 Therapy Matters Pick up

Hoopla and Brick! Timetable

9.00 – 9.15 Arrive at Therapy Matter Murwillumbah

9.15-10.15 Getting to know each other/Morning Tea

10:15 - 10:30 Walk to Hoopla Circus

10.30– 12 Hoopla Circus Activities

12 - 12:15 Walk back to Therapy Matters

12:15 - 1 Lunch/YouTube Share at Therapy Matters

1 - 3:45 Brick Club Hangout including Creative Builds + Movement games & Youtube shares

3.45 - 4.00 Therapy Matters Pick up

Child & Family Details

Child’s Name *

Child's Age *

Parent’s Name *

Phone Number *

Alternate Emergency Phone Number *

Email *

My child requires transport in a Therapy Matters team member's private vehicle to access the session? (Only available for High School Students)

YesNoUnsure

TRANSPORT COSTS MOVIE HANGOUT : $130.19 (Dover Drive to Bus & Robina Movies Return)

TRANSPORT COSTS SANCTUARY : $XXX (Dover Drive to Sanctuary Return)

I would like my child to attend (Tick all that apply):

Before Group Care (8-9am) = $43.39 - $86.79 (depending on group numbers)After Group Care (4-5pm) = $43.39 - $86.79 (depending on group numbers)

I understand that the therapy assistant supervision service is provided to parents who require before or after group care under the following conditions. I understand that I am not permitted to drop my child off before 8am. I understand that I am not permitted to pick my child up after 5pm. Overtime penalties ($240/hour) will apply for any requests for care outside of the above specified hours. Your child's costs for Before / After group care are dependent upon how many other children share the cost of this service up to $86.79/hour

Health & Safety

Therapy Matters highly values the health and safety of our clients and team. As this is an excursion in the community, we have planned for high adult to child ratios 1:1 - 1:3. We will carefully select the match between client and therapy assistant to join us on the program to ensure that they have strong respect and relationships and that they can follow any direction from our team during the day to maintain their safety in the community.

The following precautions will be taken for the excursion:

First aid kit available & at least one team member in attendance first aide trained
Wet weather contingencies available (including your provision of an umbrella or raincoat if needed for short periods of rain exposure or an alternative timetable on the day that replaces outdoor activities with indoor).
All participants to have hats, drink bottles, snacks and lunch (or money for lunch if this is an excursion offering)
Additional drink and bathroom breaks if needed
Refer to terms and conditions of the relevant venue (e.g. Bounce, Fleays, Currumbin Sanctuary and Event Cinemas)

Activity Risks and Insurance

Please also note that Therapy Matters does not have personal accident insurance cover for children. If a child is injured as a result of an accident or incident while participating in the activity, all costs associated with the injury are the responsibility of the parent/carer. Some incidental medical costs may be covered by Medicare. Some costs may also be covered by private health insurance, if available to family. Any other costs must be covered by the parent/carer. Please take this into consideration in deciding whether or not to allow your child to participate in this activity.

Please provide any further information below to support your child's health and safety on the day

Does your child have any illnesses or conditions (e.g. travel sickness, allergies) that require adjustments on the day. Please note: staff are unable to dispense medication. *

YesNo

Please describe

Does your child have asthma? *

Yes - My child's Asthma Action Plan (prepared by medical professional) will be sent to client service team No

Toileting breaks will be encouraged throughout the day at key transition points. Can your child toilet themselves, independently? *

YesNo

Please describe *

Does your child have any behaviours, actions or reactions that require specialised support?

YesNo

Please describe

In there a risk of your child running away from the group and/or facilitators? (e.g. If they feel overwhelmed, anxious or challenged by the group experience) *

YesNo

If your child is at risk of running away, it is important to let us know so we can plan appropriate risk management and supervision. To ensure the safety of your child and other group members during community outings, children with this risk will need 1:1 supervision from a therapy assistant or speech pathologist. Please note that this additional supervision will result in an increased cost for your child's group program.

Please describe the situations where this may occur *

Is your child likely to mouth or ingest inedible substances? *

Yes No

Are you or your child worried about any aspect of the excursion?

YesNo

Please describe

Does your child have any food allergies or dietary requirements *

YesNo

Please describe *

Please note that you will need to provide a packed lunch and snacks for your child for their group experience. Occasionally, we may offer additional snacks or special foods outside of these meals (e.g., popcorn during a movie or gingerbread house decorating). These will be provided in line with the dietary information you have shared with us. Do you consent to us offering these additional snacks to your child? *

YesNo

We might take photos of the group programs to share with parents of participants. Do you consent to photos being taken of your child? *

Yes I consent to photos being taken of my childNo I do not consent to photos being taken of my child

Transportation

WALKING IN THE COMMUNITY

This holiday experience will include walking in the community on footpaths and walking trails. Please read the following guidelines carefully.

Information about walking safely

Our team will walk with one team member at the front of the group and one at the back. Children will be supported to walk safely on the designated path and follow team member directions when crossing roads in designated crossing areas.

PUBLIC TRANSPORT AND COACH/TAXI TRAVEL IN THE COMMUNITY

This holiday experience will include travel by public transport (bus, train or tram) and/or Coach/Taxi. Please read the following guidelines carefully.

Information about public transport

Where public transport is to used, Therapy Matters will hold the relevant tickets to travel and abide by all guidelines and directions from the public transport entity. Children will be supervised directly by our team when travelling and are expected to follow all safety directions of our team.

TRAVEL IN TEAM'S PRIVATE VEHICLE

This holiday experience will include Therapy Matters Therapy assistant transporting your child in their private vehicle to and from the excursion venue. Please read the following guidelines carefully.

Information about the driver and their vehicle

Where private transport is to be utilised by a Therapy Assistant, Keyworker or Speech Pathologist to transport a client or their family, Therapy Matters will ensure that any person who provides private transport is the holder of a current driver’s licence, that the vehicle is registered and covered by compulsory third party insurance. The driver will also hold a valid Blue Card.

Privacy & Collection Statement

Therapy Matters is collecting information about you and your child in order to obtain consent for the holiday group experiences. The information in this form will be shared with our Client Care Team and the speech pathology and therapy assistant team members who are planning and running the holiday group experience. Your information will be stored securely in our confidential client platform, Prac Suite. Your information will not be given to any other person or agency unless Therapy Matters has obtained your consent, or the disclosure is required or authorised by law.

For more details see our Privacy Policy - Therapy Matters

Consent Form

If you wish for your child to participate in the excursion, we ask that you read and consent to the following terms:

In signing this form, I agree to all the following statements:

I hereby give permission for my child to travel by walking, public transport or private transport (as indicated in the form above) to and from the excursion venue with a Therapy Matters employee.
I acknowledge that signing this form does not guarantee my child's participation in the group and groups may not run if there is insufficient interest from other clients. You will receive confirmation at least 1 week prior to the group date.
I understand that this group program may be cancelled up to 12 hours before the start time in the event of client or staff illness, extreme weather conditions, or other unforeseen circumstances.
I have read, understood and agree to Therapy Matters Privacy & Collection Statement
I have read all the information contained in this form related to the excursion.
I am aware Therapy Matters does not have personal accident insurance cover for children.
I give consent for the child named above to participate in the excursion.
My child's NDIS funding can be claimed to cover the cost of the experience.
I understand that no refunds apply within 2 clear business days of the excursion date as per Therapy Matters standard cancellation policy.
I understand that parents do not attend the excursion but will be provided with a photo record of the day.
In the event of an accident or illness, Therapy Matters staff may obtain or administer any medical assistance, first aide or treatment the child may reasonably require, including contacting their doctor.
I accept liability for all reasonable costs incurred by Therapy Matters in obtaining such medical assistance, first aide or treatment (including any transport costs) and undertake to reimburse Therapy Matters the full amount of these costs.
I have provided Therapy Matters with all relevant details of the child's medical, health and support needs.

I agree to maintain the privacy of information gained through group program participation:

I agree to respect the privacy of individuals and information obtained through participation in the group.
I understand photos may be taken of my child in the group and agree to the secure storage of these images.
I agree to the use of images of my child to be shared amongst the group for the purposes of a record of group activity and documentation of progress against goals.
I understand and agree that no image of my child or any other child or staff of Therapy Matters is to be shared in any way privately or publicly on any social media or file sharing platform.

I agree to all of the above terms (NB failure to agree may impact your child's ability to participate)

Signature

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Date

Thank you for completing this form.

We look forward to welcoming your child on this excursion.

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