Squad Member
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mobile
Do not include area code of (+61)
eg- 040 123 1234
(###)
###
####
Diagnosis / Disability
Support Level
*
The right level of support is essential for smooth sailing when participating in our squad events or personal CAS Care. While selecting the level of support below please keep in mind: we do visit busy community areas, we swim a lot, toileting needs, eating restrictions/ assistance, medicine, health issues, ordering food, money skills and any unique behaviors. [please note any medical conditions that include seizures or very severe allergies (epi pen required) will always require one to one supervision throughout events]
Medications
Please advise of any medications taken
Swimming ability
*
Interests, likes/ dislikes, hobbies...
Please tell us why you would like to join the Community Access Squad... please be as detailed as possible.
Additional Contact 1
*
Primary contact
First Name
Last Name
*
1- Relationship to Squad Member
2- Contact number
3- Email address
Additional Contact 2
*
Secondary
First Name
Last Name
*
1- Relationship to Squad Member
2- Contact number
3- Email address
Additional Contact 3
*
Emergency- Other than parents/ guardians
First Name
Last Name
1- Relationship to Squad Member
2- Contact number
3- Email address
Is there anything else we should know?
The more we know the better we can care for you
Do you live outside of our current regions?
Not to worry we also have set pick up and drop off locations. Please pick one if you live outside the boundaries of Cockburn, Melville or Fremantle, Bunbury, Busselton, Stirling and Margaret River. (we do plan to expand outside of these cities over the coming years where you can transistion to a new region)
Which events are you interested in?
*
We run 4 different programs across the week, for more information head to the “About Us'' section on the website. Places in these programs are subject to availability and will be discussed further when you meet with a squad director.
CAS Trial period
*
We do our very best to accommodate everyone who would like to try CAS; however our program is not always the best fit. The first 4 events are a paying trial period to see if it is a suitable service. If not, we will ensure that next steps are thoroughly discussed with you.
Social Media
*
We love to use social media as a platform for squad members to share what they are achieving when out with CAS. Please let us know whether you give permission for photos/videos of the squad member to appear on our social media.
How did you hear about Community Access Squad?
CAS Illness and Injury Policy
Please copy this link below and open in a new browser. (This Document will also be emailed to you after joining up in case the link is unable to work)
https://docs.google.com/document/d/1vICHwHz0IgPX9Vlu_OgrlTEMiN1odcLBR-lFJqPNvPA/edit?usp=sharing
