WAITING LIST WAITING LIST APPLICATION Please fill out the form below to add your child to the relevant waitlist. Todays Date Child Date of Birth Child Full Name Gender Gender Male Female Non-Binary Main Language Spoken Grade Child School/Preschool Teachers Parent/Guardian Name Email Address Phone Number Relation to child Home Address Service Required Service Required Speech Pathology Occupational Therapy IQ/Learning Assessment Neurodevelopmental Assessment (ADHD, Autism etc.) Psychological Therapy/Intervention Allied Health Assistant Areas of Concern (e.g. fine or gross motor skills, speech delay, emotional regulation, articulation etc.) Any further information (This allows us to find the most suitable Therapist for your child's needs) *If Applicable* NDIS (National Disability Insurance Scheme) *If Applicable* NDIS (National Disability Insurance Scheme) Self-Managed Plan Managed *If Applicable* NDIS Plan Details 15 + 12 = Submit Thank you for contacting Capable Kids Engadine. Your child will be added to the relevant waiting list and we will contact you as soon as we have availability.