Social Skills Holiday Program 2021

Application Form


Section A - Contact Details


Section B - Further Information
If 'yes', please email copies to essendon@spectrumspeech.com.au

Section C - Health
If ‘Yes’ please ensure your child brings the Epi Pen along to each day of the program. IMPORTANT: Failure to do so will mean your child will be unable to stay for the day’s program.

Section D - Behaviour
If 'yes', please provide details below.

Does your child have difficulty with:


Section E - Payment Information

Section F - Declaration and Consent

Please check your application.

Ensure all required sections are filled in & sign below. 

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Please use your mouse or your finger on your computer trackpad to sign.