Register — Sisterup

Ready to register for a Sisterup program or service?

Please fill in this form with your details. We look forward to having you as part of the sisterhood!

Personal details

What service are you registering for today?

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Participant mobile number (if applicable)

Ability to contact participant directly, or via parent /nominee

Diagnosed Disability

NDIS participant number

Does participant have a companion card?

Health Details

Are there any personal care requirements? Please outline details if required.

Any medical information or medication requirements we should be made aware of?

Do you have any other conditions that may require special consideration for you to exercise? e.g., epilepsy, asthma, medication

Risk Summary / escalating behaviours and level (high, med,low)

Actions to take with any escalating behaviours

if applicable

Competency around water / swimming capability

Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?

Describe your current physical activity/exercise levels in a typical week by stating the frequency and duration at the different intensities.

Primary Contact Details

Primary Contact First Name

Primary Contact Last Name

Phone number of primary contact

Email of primary contact

Plan Details

Plan Managed or Self Managed

Email to send invoices to

Support Plan: The next section only applies to mentoring and supports in the community

You only need to complete this section if Sisterup is providing 1:1 support in the community. We like to discuss your support plan in person before or during your first session. This form makes sure we are ready to discuss the right things!

NDIS goals and personal goals

Options for activities during spare time (both free and paid)

Process for participating and paying for paid events, items and activities

Preferred options for food (snacks, lunches and dinners)