Yoga for Connection – Registration Form

SECTION 1: Contact & Attendee Details

Primary Contact Details

Primary Contact Name *

Email Address *

Phone Number *

Suburb/Postcode

Details of People Attending

Name of Person 1 Attending *

Age *

Does Person 1 identify as autistic?

Yes Self-identified No Prefer not to say

Name of Person 2 Attending *

Age *

What is the relationship between the people attending?

Parent / Child Partners Siblings Family members Friends Support worker / Client Other

Other (Specify)

SECTION 2: Program Selection

Which program would you like to register for? (Can select both) *

School Holiday Program (20–24 April). Open to autistic children, young people and adults attending with a parent, carer, partner, sibling, friend or significant person.5-Week Term Program (28 April – 26 May). Designed for autistic adults aged 18 years and over attending with a partner, sibling, child over 18, friend, carer or family member. ⚠ Both participants must be 18+.

School Holiday Program – Preferred Sessions

Which sessions would you like to attend? *

We plan to attend all 5 sessions 20 April (Mon) – 10:00am–11:00am – Yoga 21 April (Tue) – 10:00am–11:00am – Yoga 22 April (Wed) – 12:00pm–1:00pm – Meditation & calming postures 23 April (Thu) – 3:00pm–4:00pm – Mindfulness art 24 April (Fri) – 10:00am–11:00am – Yoga

Term Program – Preferred Sessions

Which sessions will you attend? (Multi-select) *

We plan to attend all 5 sessions 28 April 5 May 12 May 19 May 26 May

SECTION 3: Support & Accommodation Needs

We aim to create a neuro-accessible and inclusive environment. Please let us know anything that would support you (or the person attending with you) to participate comfortably.

Support, Accessibility or Accommodation Needs

Do you have any support, accessibility or accommodation needs we should be aware of?

This may include sensory preferences, communication supports, mobility needs, regulation strategies, quiet space access, seating or positioning needs, lighting preferences, predictable routines, or anything else that would help you feel comfortable and included. Please also let us know if any specific accommodations are necessary.

Sensory Preferences (Optional)

Prefer low lighting Sensitive to noise Prefer minimal music Prefer clear personal space Prefer sitting near exit Prefer mat positioned near wall Other sensory preferences

Other sensory preferences (Specify)

Communication Preferences (Optional)

Verbal instructions preferred Visual supports helpful Written instructions helpful Demonstration/modeling helpful Minimal direct interaction preferred Processing time needed before responding Other

Other (specify)

Additional Supports

Will a support worker or additional support person be attending?

Yes No Not sure

If yes, please provide any relevant information:

SECTION 4: Medical & Safety

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship to Participant(s) *

Are there any physical, mobility or health considerations we should be aware of?

Please let us know if there are any movements you prefer to avoid, any positions that cause discomfort, or any adjustments that would support safe participation. All activities can be adapted, and participants are encouraged to move at their own pace.

Are there any medical or behavioural considerations we should be aware of for safe participation?

SECTION 5: Consent

I understand these sessions are gentle wellbeing sessions (not therapy).  *

Participation is voluntary and I can rest or opt out at any time. *

I confirm the participant(s) meet the age requirements for the selected program. *

Photography Consent (Optional)

I consent to photography

I do not consent

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