Building Blocks Registration Form

Building Blocks Registration of Interest

Enter your details below if you would like to register to participate in one of the Noah's Ark Building Blocks Group Programs.
For all of our Group Programs you will need:
- Access to funds to cover the cost of the Group Program.
- A current funding plan that does not end during the Group Program (If your child is an NDIS or DET-CoS participant)
Parent Involvement
- Parents/carers are required to stay on-site, and to support their child to participate in the program. (Any child under 7 must have their parent in attendance)
To get the most out of this group you need to....
- Be able to attend to an activity for a few minutes.
- Be developing communication skills to work in a group setting with peers and facilitators.
- Be developing the fine motor skills to put LEGO® pieces together.
Which location are you interested in?*
Child's Name*

First NameLast Name
Child's Date of Birth*

DayMonthYear
I am a current Noah's Ark client*

YesNo
Child's Home Address*

Street Address

Street Address Line 2

CityState

Post Code
Parent/Carer Name*

First NameLast Name
Parent/Carer Email*
example@example.com
Parent/Carer Phone Number*
Please enter a valid phone number.
Any other comments:
Places are limited in all programs.

We will let you know ASAP if the group is already full or if we have been unable to fill the required places to run the group as planned.
How did you hear about this Group?

From Noah's Ark directlyNoah's Ark WebsiteFacebookInstagramSource Kids Expo
Date of submission

DayMonthYear
Should be Empty:

Building Blocks Registration of Interest