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FUN
WITH
DICE

NEW PLAYER REFERRAL

First name*

Last name*

Phone*

Email*

Gender and/or personal pronoun*

Date of birth*

How did you find out about us?

What age group are you?*

8 - 10

11 - 15

16 - 18+

Adult

A few words about you*

Which days are you available?

Mon

Tues

Wed

Thur

Fri

Sat

Sun

Parent or Guardian Details

Parent/guardian Name

Phone

Invoices, Plans, Payment

Select an option*

Client directly

Guardian or parent

NDIS - Plan Manager

Name of provider or person*

Plan Managers email*

Plan Managers phone

NDIS number*

NDIS start date*

Day

Month

Year

NDIS end date*

Day

Month

Year

The Details

Below we will ask a number of questions focused around us providing the best possible services to you or your loved one. Please only answer what you feel comfortable with, however the more information provided the better able we are to tailor the experience.

Are there any communication concerns or preferences?

Are there any triggers or actions that may create unease?

What environmental specifics are needed to accommodate you?

Is there a need for assistive technology that needs to be provided for?

Do you have any specific sensory needs?

Is there anything you should know of in advance about the child’s preferences or conditions you should be aware of, and if so, to what degree do these considerations affect the child

What familiarity have you with table tops games rpgs and Dungeons and Dragons.

Have you got a set of dice of your own ?

Do you have a style of play preference, or what you idea of a good adventure?

What are your no goes, what are areas of role play you consider taboo or too confronting

Is ther anything else about your personal preferences, needs or disability that we might need to take into consideration?