I Can Play Registration

Which I Can Play group are you registering for?*
Contact Name*
Participant Name*
Contact Phone*
Contact Email*
Participant Date of Birth*
Residential Suburb
Brief overview of NDIS plan/ supports currently in place (any Physiotherapy input past or current):
Reason for NDIS Plan
Does the participant have previous physical activity experience/ group education participation (positive experience, if not, why?):
Does the participant have any sport or physical exercise as part of routine at home currently? (experience with sports equipment etc.)
What would you like to get out of the multi-sports I Can Play session?
Specific needs to consider (e.g. seating/ hearing/ sensory/ communication/ socialising/ behaviour/ swallowing- texture modification needs)
Sports or physical activities you enjoy/ would like to try at I Can Play?
Who will be accompanying you to the session? (Must have guardian/support worker present at all times)
Any risks to be aware of in regards to being involved in a sports group in a community centre?
Questions for Pre and Post evaluation:
From 1-10 how confident are you with understanding different sports equipment and its purpose?
Please enter a number from 1 to 10.
1 = Not very fatigued , 10 = very fatigued
From 1-10 how comfortable do you feel participating in a physical activity group?
Please enter a number from 1 to 10.
1 = Not very fatigued , 10 = very fatigued
From 1-10 How would you rate your fatigue levels of tiredness levels after 60 minutes of activity?
Please enter a number from 1 to 10.
1 = Not very fatigued , 10 = very fatigued

Questions for Pre and Post evaluation: