Yeah The (Teenage) Girls!

Registration & Service Agreement Form Elizabeth

“Yeah, the Girls!” is a social skills program, developed and facilitated by therapists at Autism SA to support young girls aged 10 - 17 years old in navigating life as they move through the teenage years.

The group will support young girls in understanding their diagnosis, developing a sense of self and identity and support them in building confidence. The group will support participants in navigating puberty and friendships with consideration for the challenges that young girls face.

The group contains a maximum of 6 participants and 3 allied health professionals, to ensure that content is individualised and can be easily accessible for all participants. The program will run for 11 weeks and includes a written summary report at the end of the program, to detail your child’s attendance and progress within the group. The first session is a parent/guardian session, to provide you with information on the program content and will run online.

Where: Autism SA Northern Hub – 1/57 Elizabeth Way, Elizabeth

Commencement date: Thursday, 1st February 2024

Program duration: 11 x weeks (Thursdays Weekly)

Time: 3.45pm - 5.00pm

Please note that the submission of this form does not guarantee entry into this group. The first 6 participants to complete this form will secure places in the program and the remainder will be prioritised for last-minute cancellations. Our team will be in touch with you via email and SMS in the coming weeks with more information to confirm these details.

Participant Registration

Please complete and submit this form to register for the program. Once complete, your answers to the below questions will form your Service Agreement. You will be asked to agree to our Terms and Conditions and the costs of the program. You will receive a copy of your answers once submitted.

Please indicate whether you will be funding the group by NDIS or Fee for Service (FFS): *

NDISFee for service

I am... *

Plan ManagedSelf ManagedAgency Managed

Please list your Plan Manager's name and email *

I give approval for a Service Booking to be made for the value of the program

*

NDIS number *

NDIS Plan Dates *

Please upload a copy of your NDIS plan

Browse

Participant first name *

Participant last name *

Participant birth date *

Preferred Pronouns

He/Him/HisShe/Her/HersThey/Them/TheirsOther (please specify below)

Pronoun Comments

Parent/Caregiver first name *

Parent/Caregiver last name *

Email Address *

Phone number: *

How much will it cost?

The cost for this Program of Support is $1,794.38 for a 1:2 ratio for 11 sessions and includes a written summary report (193.99) at the conclusion of the program. Each session ($145.49) includes 1 hour and 15 minutes face to face and a further 15 minutes non face to face support.

If you are using NDIS funding, this can be funded under the Improved Daily Living (CB Daily Activities) Budget. Please be aware that as a Program of Support, short-notice cancellation terms do not apply for this program. Please refer to the Terms and Conditions for more information.

The relevant policies are:

T&C's Autism SA NDIS

T&C's Autism SA FFS

Yeah the Girls! Parent Survey

Yeah the Girls! Is a therapeutic group program designed to support girls with understanding their diagnosis, navigating friendships and exploring the changes they might experience in their teenage years.

To support the running of this group, we have some questions which we would appreciate your feedback on.

Is your child aware of their diagnosis? *

YesNo

Please note that this group explores their diagnosis, so this will be discussed. Please add any comments regarding this below. *

Has the child started their period? *

YesNo

If so, how do they manage this/what products do they use? *

Has the child had previous teaching on puberty and menstruation? *

YesNo

Please list any questions that the child may have, that you have been unsure on answering; *

Is there any other information you would like us to know about your child?

Please be aware that a parent session will be part of the first session and this will be running at the same time as the Yeah the Girls! Group, allowing you an insight into how the group has run. During this time, a facilitator will also be available to answer any direct questions you may have about your child.

Photographic/Video Release Authority

I grant Autism SA, its representatives, employees and suppliers the right to take/use photographs/videos of myself and/or my child/children and my property during attendance at the above-identified event/or that I have provided. I authorise Autism SA, its assigns and transferees to copyright, use and publish any and all images in pint and/or electronically at any time from now into the future. I agree that Autism SA may use such photographs with or without my and/or my child's/children's name and for any lawful purpose, including for example such purposes as marketing collateral, annual reports, publicity materials, illustration, advertising, social media and web content.

I have read and understood all of the above regarding photographic/video release authority *

YesNo

Response *

Yes I grant Autism SA the rights aboveNo I do not grant Autism SA the rights above

I have read and accept the Terms and Conditions of this service, including the Program of Support conditions.

*

I agree to the cost for the Yeah the (Teenage) Girls program as outlined above.

*

I have adequate funding available under my Improved Daily Living Budget.

*

Please sign here *

Draw signature|Type signatureClear