This form is to be completed by a parent/carer of the child.Enrolment NumberCHILD'S DETAILSChild's Name* First Last Date of Birth* Date Format: DD slash MM slash YYYY Diagnosis*What instrument would you like your child to learn?*Musical interests and skills observed (vocal and movement/rhythmic responses, styles of music, musical instruments, how does your child respond to music):Communication/social skills (such as preverbal & verbal skills, ability to relate to others):Level of comprehension/cognition (such as receptive & expressive language ability):Sensory abilities/difficulties (such as vision, hearing, touch):Physical mobility (such as ability to walk, use of wheelchair):Psychological/emotional/behavioural characteristics (confidence, ability to express self, anxiety, aggression):Any other information:GETTING TO KNOW YOUR CHILDWhen I hear music, I...Musical instruments I have at home are...The best way you can help me learn new things is by... (Step instructions? Visual cues? Modelling?)I really love… (Music? Dancing? Computer games? Outdoor play?)When I am doing something I love, I can do that for (how long)?I don’t like… (Loud noise? Large crowds? Being out of routine?)I express what I want and what I don’t want by…When I feel happy/upset/angry, I can express my feelings by...AVAILABILITYAvailability for weekly sessions:* Monday Tuesday Wednesday Thursday Friday Saturday(Monday) time/s available*(Tuesday) time/s available*(Wednesday) time/s available*(Thursday) time/s available*(Friday) time/s available*(Saturday) time/s available*Your child will be accessing this service through:*NDIS NDIA Managed fundingNDIS Plan Managed fundingNDIS Self Managed FundingPrivate ClientOtherPlease Specify*PARENT/CARER'S DETAILSParent/Carer's Name* First Last Relationship to the Child:*Address* Street City State Postcode Phone*Email* How did you find out about Sound Expression?Terms and Conditions* I have read and understood the Terms & Conditions and any questions I have asked have been answered to my satisfaction*NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.