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Are you interested in improving your father-son relationship? 

Please complete the following questionnaire and registration form to express your interest in joining our pilot program!

Successful applicants will receive a thank you gift pack thanks to our wonderful donors. More details to come! 

If you require support to complete this form, please contact our team on (08) 6297 0737. 
 

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* 1. Are you ready to step forward and reinvest in your relationship?

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* 2. I would like to register as a 

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* 3. What is your full-name

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* 4. What is your best contact number?

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* 5. Do either of you reside in the City of Swan?

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* 6. Are one of you an NDIS participant?

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* 7. On a scale of 1 (Not Good) to 5 ( Very Good), how would you rate your relationship with your father/son?

1 Not Good 2 It's ok, we have good days and bad days 5 Very Good
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i We adjusted the number you entered based on the slider’s scale.

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* 8. Do you believe the relationship is beyond repair?

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* 9. Can you and your father/son commit to attending the program on a Saturday, once a week for 6 weeks?

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