Step 1 of 8 12% Name of Participant in Group Program(Required) First Last Is the participant under 18 years of age?(Required) Yes No Name of Parent/Caregiver(Required) First Last Date of Birth of Group Participant(Required) Day Month Year Are you an existing client with Young Minds Health and Development Network (within the last 12 months)?(Required) Yes No Phone(Required)Email(Required) Do you have a current referral?(Required) GP referral Paediatrician referral Psychiatrist referral NDIS Self Managed NDIS Plan or Agency Managed No referral yet or paying privately Other Please select all groups you are interested in(Required) Children’s Group Programs Adolescent Group Programs Parent Group Programs Adult Group Programs Children’s Group Programs Scuba Sam’s Social Adventure (4-7 Years) Positive Penguins (4-7 Years) Fact or Fiction Jnr (5-8 Years) Social Scientists (6-8 Years) Hunter’s and his Amazing Remote Control (6-8 Years) CHOICES (8-11 Years) Fact or Fiction (8-11 Years) Secret Agent Society (8-12 Years) Lego Builders School Holiday Program (5-9 Years) I am… Yoga & Art School Holiday Workshop (6-11 Years) Adolescent Group Programs Level Up (12-15 Years) Body Project Parent Group Programs Circle of Security Adult Group Programs Please indicate your first preferred location(Required)StaffordThe Gap (Please note that there are currently no Groups planned for this location in 2022)North LakesRedcliffePlease indicate any other locations you would be willing to travel to Stafford The Gap (N.B: No current groups planned) North Lakes Redcliffe
