Play Skills ProgramJanuary 24-25, 2022 12-3.30pm Survey

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* 5. How do you plan to fund 's participation in the group? *Prices subject to change in line with any ndis pricing schedule reviews.

The cost of this group is approximately $670 depending on the number of children in the group

Through NDIS funding, (I know that there are funds available to use for the group)

Through NDIS funding, (I will need support to identify if there are available funds / where to take funds from)

Through NDIS funding (self managed)

Privately funded

Other

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* 6. Is your child currently toilet trained?

Yes

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* 7. Has your child engaged in a small group activity before? (e.g. playgroup or childcare)

Yes

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* 8. The group usually includes a brief snack time, does your child need support with eating and/or drinking?

Yes

If so, please provide detail.

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* 9. Are there any key triggers for your child?

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* 10. What do you do to support your child to calm down?

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* 11. How would you rate __ What is your child's skills in the following areas:

(1 being the lowest, 10 being the highest)

There are 7 rating questions, please rate each of the questions below as this information will be used to track 's progress in these areas.

	1	2	3	4	5	6	7	8	9	10
Your child's ability to take turns	Your child's ability to take turns 1	Your child's ability to take turns 2	Your child's ability to take turns 3	Your child's ability to take turns 4	Your child's ability to take turns 5	Your child's ability to take turns 6	Your child's ability to take turns 7	Your child's ability to take turns 8	Your child's ability to take turns 9	Your child's ability to take turns 10
Your child's ability imitate actions within a song	Your child's ability imitate actions within a song 1	Your child's ability imitate actions within a song 2	Your child's ability imitate actions within a song 3	Your child's ability imitate actions within a song 4	Your child's ability imitate actions within a song 5	Your child's ability imitate actions within a song 6	Your child's ability imitate actions within a song 7	Your child's ability imitate actions within a song 8	Your child's ability imitate actions within a song 9	Your child's ability imitate actions within a song 10
Your child's ability to sit and listen to a book	Your child's ability to sit and listen to a book 1	Your child's ability to sit and listen to a book 2	Your child's ability to sit and listen to a book 3	Your child's ability to sit and listen to a book 4	Your child's ability to sit and listen to a book 5	Your child's ability to sit and listen to a book 6	Your child's ability to sit and listen to a book 7	Your child's ability to sit and listen to a book 8	Your child's ability to sit and listen to a book 9	Your child's ability to sit and listen to a book 10
Your child's ability play with others	Your child's ability play with others 1	Your child's ability play with others 2	Your child's ability play with others 3	Your child's ability play with others 4	Your child's ability play with others 5	Your child's ability play with others 6	Your child's ability play with others 7	Your child's ability play with others 8	Your child's ability play with others 9	Your child's ability play with others 10
Your child's ability engage in imaginary play	Your child's ability engage in imaginary play 1	Your child's ability engage in imaginary play 2	Your child's ability engage in imaginary play 3	Your child's ability engage in imaginary play 4	Your child's ability engage in imaginary play 5	Your child's ability engage in imaginary play 6	Your child's ability engage in imaginary play 7	Your child's ability engage in imaginary play 8	Your child's ability engage in imaginary play 9	Your child's ability engage in imaginary play 10
Your child's ability label common items	Your child's ability label common items 1	Your child's ability label common items 2	Your child's ability label common items 3	Your child's ability label common items 4	Your child's ability label common items 5	Your child's ability label common items 6	Your child's ability label common items 7	Your child's ability label common items 8	Your child's ability label common items 9	Your child's ability label common items 10
Your child's ability to follow basic instructions	Your child's ability to follow basic instructions 1	Your child's ability to follow basic instructions 2	Your child's ability to follow basic instructions 3	Your child's ability to follow basic instructions 4	Your child's ability to follow basic instructions 5	Your child's ability to follow basic instructions 6	Your child's ability to follow basic instructions 7	Your child's ability to follow basic instructions 8	Your child's ability to follow basic instructions 9	Your child's ability to follow basic instructions 10

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* 12. Is there any other information you would like to share about your child?

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* 13. What is the best Phone number to contact you on?

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* 14. What is your preferred email address?

Thank you for taking the time today to complete these questions. This will provide us with important information in planning for groups. We will contact you to confirm and make a booking once minimum numbers have been reached.

Play Skills Program
January 24-25, 2022 12-3.30pm

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* 1. What is your name?

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* 2. What is your child's name?

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* 3. What is your child's date of birth?

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* 4. Does your child currently attend Talking Matters?

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* 5. How do you plan to fund 's participation in the group? *Prices subject to change in line with any ndis pricing schedule reviews.

The cost of this group is approximately $670 depending on the number of children in the group

Question Title

* 6. Is your child currently toilet trained?

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* 7. Has your child engaged in a small group activity before? (e.g. playgroup or childcare)

Question Title

* 8. The group usually includes a brief snack time, does your child need support with eating and/or drinking?

Question Title

* 9. Are there any key triggers for your child?

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* 10. What do you do to support your child to calm down?

Question Title

* 11. How would you rate __ What is your child's skills in the following areas:

(1 being the lowest, 10 being the highest)

There are 7 rating questions, please rate each of the questions below as this information will be used to track 's progress in these areas.

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* 12. Is there any other information you would like to share about your child?

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* 13. What is the best Phone number to contact you on?

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* 14. What is your preferred email address?

Play Skills ProgramJanuary 24-25, 2022 12-3.30pm

Question Title

* 1. What is your name?

Question Title

* 2. What is your child's name?

Question Title

* 3. What is your child's date of birth?

Question Title

* 4. Does your child currently attend Talking Matters?

Question Title

* 5. How do you plan to fund 's participation in the group? *Prices subject to change in line with any ndis pricing schedule reviews.The cost of this group is approximately $670 depending on the number of children in the group

Question Title

* 6. Is your child currently toilet trained?

Question Title

* 7. Has your child engaged in a small group activity before? (e.g. playgroup or childcare)

Question Title

* 8. The group usually includes a brief snack time, does your child need support with eating and/or drinking?

Question Title

* 9. Are there any key triggers for your child?

Question Title

* 10. What do you do to support your child to calm down?

Question Title

* 11. How would you rate __ What is your child's skills in the following areas:(1 being the lowest, 10 being the highest)There are 7 rating questions, please rate each of the questions below as this information will be used to track 's progress in these areas.

Question Title

* 12. Is there any other information you would like to share about your child?

Question Title

* 13. What is the best Phone number to contact you on?

Question Title

* 14. What is your preferred email address?

Play Skills Program
January 24-25, 2022 12-3.30pm

* 5. How do you plan to fund 's participation in the group? *Prices subject to change in line with any ndis pricing schedule reviews.

The cost of this group is approximately $670 depending on the number of children in the group

* 11. How would you rate __ What is your child's skills in the following areas:

(1 being the lowest, 10 being the highest)

There are 7 rating questions, please rate each of the questions below as this information will be used to track 's progress in these areas.