Expression of Interest/Referral - New Camper :: People Outdoors | Outdoor experiences for people with disabilities

Upcoming Program
Referral Form

PLEASE NOTE: The Intake Process for new campers will take approximately 4-6 weeks from date of expression of interest.

Expressing your interest to attend camp, does not gurantee your placement on camp. Waiting lists may apply.

Name of Applicant Required

Address Required

Date of Birth Required

Name of Contact Person (Parent/Guardian/Next of Kin/Emergency Contact) Required

Contact Person's Relationship to the Applicant/Camper Required

Email Address of Applicant

Email address of Carer / contact person / next of kin Required

Mobile/Phone Number of Applicant/Camper Required

Mobile/Phone Number of Contact Person (Parent/Guardian/Next of Kin/Emergency Contact) Required

with your family

in supported living accommodation

other

Date of Camp Preferred Required

Do you (applicant/camper) live with (please select which applies) Required

Your Family

In Supported Independent Living (SIL)

Specialist Disability Accommodation (SDA)

Other

Have you been away from home before? Required

Yes

If yes, where have you stayed?

Do you have an NDIS package? Required

Yes

Do you have enough funding for all the camps preferred? Required

Yes

What funding is available? Required

Do you have Short Term Accommodation (STA) within your core supports?

Yes

How is your NDIS package managed? Required

If managed multiple ways, please list:

NDIS Number: Required

Plan Dates (including expiry): Required

Plan Management Details (if applicable)

Self Management Details (if applicable)

Support Coordinator or Local Area Coordinator (LAC) details (name and contact details):

Are you happy to share a copy of the NDIS plan?

If you do not wish to share the NDIS Plan, can you please provide the participant’s goals stated in the NDIS plan relevant to camp below as they form a part of the of the case notes completed by the Disability Support Worker on camp:

Do you need assistance in any of the following areas (please tick all that apply):

If you selected Personal Care above, please provide us more information about the care you require:

Do you have a Behavior Support Plan?

Yes

Support ratio required Required

1:1

1:2

1:3

Do you require support during the night Required

Yes

If you do require support during the night, please provide more information here:

Do you have any medical conditions or need any special assistance (e.g. peg fed, anaphylaxis etc.)?

Do you use any mobility aids? Required

Yes

If you do use mobility aids, please provide more information here:

Do you have any special interests (e.g. horse riding, craft, ball games etc.)?

Do you have any specific goals you would like People Outdoors to help you achieve on a program?

What would you like to get out of the People Outdoors program?

How did you find out about People Outdoors? Please tick and provide details: Required

Case Manager

Plan Manager / Support Coordinator

School

Expo

I am a current camper

Internet search

Social media

Word of mouth

Other

When would you prefer us to try and contact you? Required

Privacy Statement: People Outdoors is committed to protecting the privacy of your personal information. The information on this form is collected for the primary purpose of selection for our programs. If you choose not to complete all the questions on this form, your application may not be considered. Personal information may also be disclosed to the relevant authorities in the event of a medical emergency. If you wish to access your personal information or inquire about the handling of your personal information, please contact People Outdoors on (03) 9863 6824.

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Upcoming Programs

VIC: Adults Weekend Camp

Lake Dewar Discovery Camp
Adults (18yrs+)
17-05-2024 - 19-05-2024

weekend

Join us at Lake Dewar Discovery Camp for this Weekend Camp (2 nights).

This camp is for Adults (18yrs+) living with disability. Please note this camp will depart from our Melbourne departure point in Thornbury.

Some of the activities you might participate in are canoeing, archery, low ropes and more!

New to People Outdoors camps? Please complete the referral form so we can begin the intake process (note: completion of the intake process is required prior to attending any camp).

ENQUIRE (New Camper) ENQUIRE (Returning Camper)

VIC: Adults Camp | Mornington Peninsula

Camp Manyung
Adults (18yrs+)
31-05-2024 - 02-06-2024

weekend

Join us at Manyung Discovery Camp for this Weekend Camp (2 nights).

This camp is for Adults (18yrs+) living with disability. Please note this camp will depart from our Melbourne departure point in Thornbury.

Some of the activities you might participate in are high ropes course, archery, campfire cooking and more!

New to People Outdoors camps? Please complete the referral form so we can begin the intake process (note: completion of the intake process is required prior to attending any camp).

ENQUIRE (New Camper) ENQUIRE (Returning Camper)

VIC: Kids & Teens Camp | Gembrook

Stringybark Lodge
Kids & Teens (6-17yrs)
14-06-2024 - 16-06-2024

weekend

Join us at Stringybark Lodge for this Weekend Camp (2 nights) in Gembrook.

This camp is for Kids and Teens (6-17yrs) living with disability. Please note this camp will depart from our Melbourne departure point in Thornbury.

Some of the activities you might participate in are mountain biking, archery, low ropes and more!

New to People Outdoors camps? Please complete the referral form so we can begin the intake process (note: completion of the intake process is required prior to attending any camp).

ENQUIRE (New Camper) ENQUIRE (Returning Camper)

	03 9863 6824
	Corporate One, 84 Hotham St Preston VIC 3072 AUSTRALIA
	peopleoutdoors@auscamps.asn.au