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Home
Services
Therapy
Occupational Therapy
Clinical Psychology
Behaviour Support Services
Somatic Movement Therapy
Therapy Intensive Session Blocks
Group Therapy Programs
Creative Minds
Sense Rugby
In Motion
Pre Kindy Group
Parent Workshops and Groups
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
East Kimberley Clinic
Functional Assessments
Therapy Intensive Session Blocks
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Home
Services
Therapy
Occupational Therapy
Clinical Psychology
Behaviour Support Services
Somatic Movement Therapy
Therapy Intensive Session Blocks
Group Therapy Programs
Creative Minds
Sense Rugby
In Motion
Pre Kindy Group
Parent Workshops and Groups
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
East Kimberley Clinic
Functional Assessments
Therapy Intensive Session Blocks
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Home
Services
Therapy
Occupational Therapy
Clinical Psychology
Behaviour Support Services
Somatic Movement Therapy
Therapy Intensive Session Blocks
Group Therapy Programs
Creative Minds
Sense Rugby
In Motion
Pre Kindy Group
Parent Workshops and Groups
Therapy Camps
Adventure Camps
Boys Camps
Camp Confidence
Girls Camps
East Kimberley Clinic
Functional Assessments
Therapy Intensive Session Blocks
Events
Resources
For Teachers and Parents
For Therapists and Students
Therapy Camp Supports
For Police and First Responders
Fees and Rebates
NDIS Funding
Search
Mother’s Education Retreat Application Form
Date form Completed:
DD slash MM slash YYYY
Contact Details
Name:
*
Primary Phone Number:
*
Email:
*
Preferred Method of Contact:
Email
Phone Call
Text
Which Mothers Intensive Training would you like to attend? You can select multiple if you don't have preference of dates.
*
6-8th March 2026
26-28th June 2026
21-23rd August 2026
13-15th November 2026
Emergency Contact Details
Name:
*
Relationship to you:
*
Phone Number:
*
Medical information
Do you have any medical conditions or allergies that we need to be aware of?
*
Yes
No
Please provide details
*
Do you experience seizures?
*
Yes
No
Do you have any dietary needs, restrictions or preferences?
About You
Would you like to have a massage/facial on the retreat?
*
Massage please
Facial please
Neither thank you
What are your goals or reason for attending Mothers Intensive Training?
Will you be using NDIS funding to attend this retreat?
*
I will be using my child's NDIS Funding
I will use some of my child's NDIS Funding and privately pay the rest.
I will be using my own NDIS funding
I am privately paying the whole amount
Please note there is a private paid portion of $350 as we are not able to use NDIS funding to cover food and accomodation.
What is your child's name?
*
Is there anything else we need to know?
Payment Type
*
NDIS managed
Self managed NDIS
Plan Managed NDIS
Privately Paid
NDIS Number if we don't already have it:
Plan Manager details if we don't already have it:
Copy of NDIS Plan if we don't already have it:
Max. file size: 128 MB.
Commitment Form
Participation in Calm and Connected’s Therapy Intensive programs requires a firm commitment due to the intensive planning, staffing and purchasing of materials in advance. Once your child has been accepted into the program our financial commitment to your child in camp has begun. As a courtesy between families and Calm and Connected, as well as for clarity regarding financial commitment for families, please tick that you agree to the following:
Before continuing please read our Terms of Service which can be found here: https://calmandconnected.com.au/termsofservice/
*
I understand that the deposit is required to confirm my place
I understand that this deposit is non-refundable
I understand that the remaining payment installments are non-refundable after the dates specified on the website.
I agree to Calm and Connected's Terms of Service
Before continuing please read our Terms of Service which can be found here: https://calmandconnected.com.au/termsofservice/
Name:
*
Date:
*
DD slash MM slash YYYY
X
X
