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Floriade Canberra 2024
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Need Care Support?
Respite Care / STA Booking Request Form
Participant Name
(Required)
May we please know the brief of diagnosed disability?
(Required)
Date of Birth
DD slash MM slash YYYY
Gender
(Required)
Male
Female
Prefer Not to Say
Others
How is your plan managed?
(Required)
I have a Plan Manager
It is managed by NDIS
I am managing by myself
If your plan is Plan Managed, Kindly provide us Name and Contact details of your Plan Manager.
Kindly provide us with the Name, Email, Phone Number
Accommodation Details
Check In Date
DD slash MM slash YYYY
Check Out Date
DD slash MM slash YYYY
Location / Areas / Suburbs you would prefer to live
(Required)
Please try to give us few options so that we can organise something better for you.
What type of Accommodation are you looking for?
(Required)
Units / Flats
Independent Homes
Hotel Rooms
Other
Select All
Please select whatever is your choice.
Do you need disability accessible room or accommodation?
(Required)
Yes Wheelchair Accessible
No
Other
Would you also need local transportation?
(Required)
Yes
No
Other
Please note the transportation can be provided only for the participant
Do you also want to visit some other local places as a part of Community Participation?
(Required)
Yes, I would like to explore locally
No Thanks!
Other
If you would like to visit locally, please provide us with some more information such as dates, locations, etc.
How many rooms do you need?
(Required)
How many bathroom do you need?
(Required)
Any other information would you like to provide us to help coming up with great options?
(Required)