Client and summer group details

Is the child a current or past BlueRocket client? *

Yes, a current clientYes, a past clientNo, but they’re on the BlueRocket waitlistNo, they’re new to BlueRocketNot sure

Which group are you interested in? (tick all that apply) *

Kindy & Pre-primary Ready, ages 3–5: twice a week (Thu and Fri, 8:30–10:30am)Kindy & Pre-primary Ready, ages 3–5: once a week (Wed, 8:30–11:00am)Food Explorers, ages 4–8: exploring new foods, no pressureFeelings Kingdom, ages 5–7: naming feelings and finding calmHandwriting Heroes juniors, ages 7–9: handwriting skills and confidenceHandwriting Heroes seniors, ages 10–12: handwriting skills and confidenceBuilders Club juniors, ages 7–9: building, planning and teamworkBuilders Club seniors, ages 10–12: building, planning and teamworkMission Calm, ages 8–11: big feelings and calming strategiesHigh School Ready, ages 11–13: getting ready for high schoolTeen Art Studio, ages 13–16: art, chatting and making friendsNot sure, please help us choose

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Your details

Are you the child’s parent or carer, or a support coordinator? *

Parent or carerSupport coordinator or other professional

Your First Name *

Your Last Name *

Your Mobile Phone Number *

Your Email Address *

Parent/Carer details

Parent/Carer First Name *

Parent/Carer Last Name *

Parent/Carer Email *

Parent/Carer Mobile Phone Number *

Form Submission

Anything else you'd like us to know?

i unerstand and agree to BlueRocket Therapy's Privacy Policy *

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