YLOT Holiday Buddies Program

Expression of Interest

Please register your Expression of Interest to participate in our 'Holiday Buddies' Program. A YLOT representative will be in touch with you to discuss. EOI's for bookings for Autumn close on the 31 March.

Our Autumn 2025 Program will operate from Monday 14th - Thursday 17th April (Closed Good Friday 18th April)

Child's Name: *

First

Last

Date of Birth: *

Age:

Parent/Guardian Details:

Name: *

First

Last

Address:

Address L

City:

State:

Postcode:

Phone Number:

Email: *

Workplace (if applicable):

Child's School: *

Class: *

Teacher Name: *

Teacher's Email *

I give permission for YLOT to contact my child’s class teacher to discuss learning goals.

NDIS Number: *

My child’s NDIS plan is: *

Self Managed
Plan Managed
NDIA Managed (Unfortunately we cannot accept participants in this category at this time)

My child has sufficient funds in their NDIS plan to cover the holiday program *

Yes
No
Unsure (please contact your plan manager or YLOT for a quote if unsure)

Please indicate which NDIS Plan category to charge your child's program fees: *

Core Supports (social & community participation)
CB (Social and Community Participatiion)
CB (Improved Relationships)
CB (Improved Daily Living)
Unsure (please contact your plan manager if unsure)
Private fee-for-service (non NDIS)

Plan Manager: (if applicable)

First

Last

Plan Manager Email:

Plan Manager Phone Number:

Support Coordinator: (if applicable)

First

Last

Support Coordinator Email:

Support Coordinator Phone Number:

Emergency Contact 1

Name: *

First

Last

Relationship:

Phone Number:

Emergency Contact 2

Name: *

First

Last

Relationship:

Phone Number:

Session Details:

Please note all days requested may not be confirmed due to a high volume of bookings. Booking requests will close two weeks before starting date-

I am requesting my child attend on the following days: *

Monday 14 April, 2025
Tuesday 15 April, 2025
Wednesday 16 April, 2025
Thusday 17 April, 2025

My child uses a wheelchair:

My child has a behaviour management plan:

My child has 'regulated restrictive practices' authorised in an NDIS approved behaviour management support plan:

If yes, as an unregistered NDIS provider, YLOT are unable to enforce regulated restrictive practices. Please contact us to discuss further.

My child has a meal management plan:

My child has a medical action plan (eg Asthma, seizure management, etc):

My child has an Individual Education Plan (IEP) or Learning Plan (LP) at school:

My child has a manual handling plan:

I give permission for my child’s plans above to be shared with YLOT by my child’s school, to assist with individual planning for support.

I have included a copy of the above plans.

Please attach copy of plans here, if you have them:

Click or drag a file to this area to upload.

Please list any allergies:

Please list any medications taken during the day (note If your child needs medication during the program you will need to provide us with a signed medication chart from their GP):

Please list any additional info:

Holiday Program Participant Profile

To enable our staff to best meet your childs needs we ask that you complete the following questions for us to be able to create a Profile for staff to assist in supporting your child.

Please attach a photo of your child

Click or drag a file to this area to upload.

What is important to me?

What do people like and admire about me?

What do I like doing?

Things I don’t like:

How can you best support me (including toileting information):

Please give any other information that will enable us to best support your child at The Holiday Program, including diagnosis information if happy to share:

Media Consent

We love taking photos of our buddies and participants having fun together in our holiday activities. Please outline below if you consent for your child to be photographed, videod on the day and for these to be shared on our social media or website. *

Yes, I consent for media
No, I would prefer no media of my child/ren

Signed (Type name) *

Date: *

Comment

“Thank you for giving us not only such a valuable opportunity, but also for allowing us to grow, to connect, to empathise and to be a part of something which is so much greater than ourselves

LEADERSHIP THROUGH PERSONAL GROWTH

YLOT OFFICE
Suite 5 Bellerive Quay
31 Cambridge Road
Bellerive TAS 7018

PHONE
0428 640 320

EMAIL
hello@ylot.org.au

© 2025 Young Leaders of Tasmania Ltd 
 ABN 96 624 570 510 

We are a registered charity, your donations are tax-deductible and will go directly towards our programs for young people living with disability.