Occupational Therapy Parent Group Intake Form

This form must be completed to confirm your child’s 1st session booking:

  • Child's Details

  • I acknowledge that photographic/video material of my child may form a part of the assessment or records. I understand that photographic or video material of group activities may be disseminated to parents/caregivers of children who attend the group. This provides parents/caregivers information about activities that are beneficial to support skill development at home as well as providing a prompt for discussion with their child about what they did in the group. I understand that photographic or video material will not be used for any other purpose without my permission.

    I understand the cost of the group will be deducted from the credit card provided two weeks prior to the commencement of the group program. Please ensure sufficient funds are available on debit cards, if not a $10 admin fee will apply.

    The above terms and conditions are specific to the group program your child will be attending and are in addition to the general Jump Up For Kids terms and conditions (see below). *

  • Sign in the box above with mouse or your finger on touch screen in order to agree to the Jump Up for Kids Terms and Conditions and Privacy Policy