Teen Night Out

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For Young Teens with Disabilities aged 15-18 to develop their social and independence skills in an environment of like minded young men in a safe, inclusive and fun environment!

When: Tuesday - 5:30pm to 8:30pm (During the School Terms)

Thursday - 5:30pm to 8:30pm (Full Capacity)

Where: Vibe Hive - 339 Cambridge Street, Wembley

How: 1:1 Mentoring though an NDIS Plan

Fill out the form below to get started!

General Information

First Name*

Last Name*

Age*

Full Address*

NDIS Number*

Primary Email*

Primary Phone

How did you find out about us?

Emergency Contact Information

Emergency Contact*

Emergency Contact Phone Number*

Emergency Contact's Relationship to you*

About You

What do you hope to gain from this program?

What are some of your favourites activities or things to do in your free time? ( e.g hobbies, sports, interests)

Can you commit to attending the program every week?

Consent

Program Eligibility: Acceptance into the program is subject to evaluation by Dynamic Support WA to ensure that the program is a suitable fit for the participant's needs.

Communication: By providing your contact details, you consent to being contacted by Dynamic Support WA for the purpose of program coordination, scheduling, and updates related to this Program.

Confidentiality: Dynamic Support WA are committed to protecting your privacy. Personal information provided on this form will be used solely for program-related communication and coordination and will not be shared with third parties without your explicit consent.

Photography and Media: You acknowledge that photographs or videos may be taken during program activities. Dynamic Support WA reserves the right to use these images for promotional and marketing purposes. If you have concerns regarding the use of your or your child's image, please notify us in writing.

Program Changes: Dynamic Support WA reserves the right to make changes to the program schedule, format, or location as deemed necessary. Participants will be notified of any significant changes in a timely manner.

Health and Safety: Participants are responsible for disclosing any relevant health information, including specific needs related to disabilities, that may impact their participation in program activities. Dynamic Support WA will take reasonable steps to accommodate and ensure the health and safety of participants during program sessions.

By ticking this box, you confirm that you have read, understood, and agreed to the terms outlined in this 'consent' disclaimer.*

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