Skip to: Navigation
Skip to: Main Content
menu
✕
Close
Home
Services
Resources
Partner with us
About
Who we are
Governance
Our history
Our difference
News
Events
Careers
Career opportunities
Working at Lifestart
Support us
Donate
Pay an invoice
Contact us
1800 953 390
Donate
Give feedback
Search
clear
Donate
Give feedback
NDIS
Registered
Provider
Lifestart
>
Expression of Interest for Secret Agent Society
Secret Agent Society
Expression of Interest
Expression of interest for Secret Agent Society
Child's name
*
Child's age
*
Under 6
7
8
9
10
11
12
13 or older
Child's disability (please tick all that apply)
Autism
ADHD
Anxiety
Developmental delay
Speech delay
Intellectual disability
My child has not been diagnosed with a disability
Other (please specify)
If other, please specify
Parent/carer name
*
Email address
*
Phone number
*
Availability: Please choose one of the options below
*
I am available for the next online program.
I am not available for this program but I would like to register my interest in future programs.
I am available for future sessions on:
Monday
Tuesday
Wednesday
Thursday
Friday
Add more details (optional)
I understand there is a cost to attend the group. I can use my child's NDIS plan to pay for it.
Yes, confirm
How did you hear about the program?
*
My keyworker at Lifestart
Email from Lifestart
Lifestart website
Social media
Word of mouth (please specify below)
If word of mouth, please specify:
Hidden
Next steps: Please choose one of the options below
*
I would like to book a free 20 minute consultation to help me decide if the program is right for me and my child.
I have all the information I need and am ready to sign up.
Hidden
Child's age
*
Hidden
Which of the following statements apply to your child? Please tick all that apply
Has a diagnosis of Autism
Has social communication difficulties
Wants to work on social skills goals
Is interested in participating in an online group with peers
Hidden
My child is available for sessions after school:
Monday
Tuesday
Wednesday
Thursday
Friday
Hidden
Add more details (optional)
This site is protected by reCAPTCHA and the Google
Privacy Policy
and
Terms of Service
apply.
Error: