• MUDDY PUDDLES REGISTRATION

    MUDDY PUDDLES REGISTRATION

    Please complete this form to register as a client of Muddy Puddles.

  • PARENT/CARER DETAILS

    The person completing this form should be the person responsible for decisions regarding the child ("client") to be registered
  • Are you the legal guardian of this child?*
  •  -
  • Format: 0000-000-000.
  • What is your preferred method of communication
  • Do you receive Carers' Allowance in relation to your child?
  • How will you be paying for the services provided by Muddy Puddles?*

  • Does this apply to you?

  • DETAILS OF CHILD OR YOUNG PERSON TO BE REGISTERED

  • Date of birth*
     - -
  • Does your child identify as
  • Select the development areas your child may benefit from

  • Which services are you interested in accessing at Muddy Puddles?

  • Are you interested in attending workshops for parents and carers on the following topics:

  • Are you interested in accessing student led services?
  • Does your child have a diagnosed disability?*
  • Are your child's immunisations up-to-date?*
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  • CONSENT TO EXCHANGE INFORMATION

    To provide consistent and high quality support to your child, it is often necessary to discuss their support plan and progress with other people involved in the care or support of your child. Please list the people or organisations you permit us to exchange information with ("information" includes verbal, written or electronic health and development records).
  • Please add people you give us permission to exchange information with

  • CONSENT TO TAKE AND USE PHOTOS

    When providing supports to your child, we may take photos of the session. Please review how we may use these photos and let us know if you consent to the use of photos in each case.
  • I give permission for photos of my child to be used to record their progress and appear in progress reports (seen by Muddy Puddles team and family)*
  • I give permission for photos of my child to appear in the Muddy Puddles Centre (For example to demonstrate what has been happening in programs. These will be seen by other Muddy Puddles clients accessing the Centre.)*
  • I give permission for photos of my child to be used for marketing and promotional purposes, including newspaper articles, flyers, presentations, social media (eg. Facebook)*
  • If you answered "Yes" to allowing photos to be used for marketing purposes, do you give permission for your child's name to be used also?

  • SHARING YOUR CHILD'S NDIS PLAN

  • You can choose who you share your child's NDIS plan with, and which parts they can see.

    If you choose to share your child's NDIS plan with Muddy Puddles, it will assist our team to work towards your child's NDIS goals.  If you choose to share details of your child's NDIS plan budget it allows Muddy Puddles to develop a Schedule of Supports in line with your available funds and support categories.

    If you choose not to share your child's NDIS plan with Muddy Puddles, then you agree to pay any out of pocket expenses incurred for services provided if they exceed the limits of your available NDIS budget. This option also limits the information we can provide to assist you with your NDIS plan reviews.

  • I consent to sharing the following parts of my child's NDIS plan with Muddy Puddles:
  • NDIS plan start date:
     - -
    2 digit day, 2 digit month, 4 digit year
  • NDIS plan end date:
     - -
    2 digit day, 2 digit month, 4 digit year
  • Management type:

  • FAMILY DETAILS

  • Is your child in the care of

  • EMERGENCY CONTACT DETAILS

    Please provide the contact details of someone other than the parent/carer submitting this form.
  •  -
  • Format: 0000-000-000.

  • AGREEMENT

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  • Should be Empty: