Client Registration

Learning Creative Skills

A charity that provides a range of supports to people with a disability to enable individuals meet their goals and aspirations in all aspect of life.

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(08) 7289 0242

Participants Registration of Interest form

Client Registration Form

Personal Information

Person’s name

D.O.B

Parent/Guardian Names

Residential Address

Phone Number

Address

Daytime Contact No.

Accommodation Email

Accommodation Services (if applicable)

No. of Days Requested

Mon Tue Wed Thu Fri Sat Sun

Trial Day Required?

Yes No

Does Participant Require Transport?

Yes No

Type of Disability and Level of Support Needs (medium, high etc)

If Known, How Will You Pay for the Service?

Do you have a current NDIS Plan?

Participant Number

Plan Start Dates

Plan End Dates

Managed By

Specific Support Requirements

Toileting

Mobility

Medications

Communication Verbal/written

Behavioural

Diet

Allergies

Additional Info

LCS Notes

What are his/her special interests?

What activity does he/she like doing? Eg Bowling, Swimming, Music, Art, Outing, Cooking, Socialising etc…

What are his/her current goals?

What other goals he/she would like to achieve?

Any Other Message?

Contact Us

Address: 16 Lakeland Road, Munno Para West, SA 5115
Phone: (08) 72890242
Mobile: 0412141292
0432533140
Email: infolcs77@gmail.com
infolcs69@gmail.com

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We acknowledge the Kaurna people as the traditional custodians of the Adelaide Plains. We recognise and respect their cultural heritage, beliefs and relationship with the land. We pay our respects to Elders past, present and future.

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