Client Registration

Families may apply for CoastAbility Client Registration for children and young people from birth to age 25 with an identified physical disability, living in the NSW Central Coast area. 

Doctors and therapists may be involved in the initial referring of families to CoastAbility.

Please Note:

  • Client Registration applications must include current reports from relevant doctors and/or therapists. These documents will need to identify any diagnosed medical conditions and outline the degree of impact of physical disability on the young person’s functioning and mobility.
  • Completion of the the relevant Social Media Consent form is greatly appreciated. Consent enables us to promote the work of CoastAbility within the community. 

Client Registration Form

Download PDF

Client Registration Form

Parent / Carer / Next of Kin Name(s) and Contact Details (Please complete sections below)

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Other Contacts / Organisations

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Siblings:

GP, Specialist, Therapist Contact Details

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Maximum file size: 134.22MB

Social Media Consent

For our records, you are required to complete the Social Media Consent form before submitting your application. Whilst we greatly appreciate your acceptance as this assists us to promote the work of CoastAbility, we totally respect the choice of Clients and Carers to deny consent.

Social Media Consent:
Authorisation for Minor (Under 18):

NB: You will automatically be emailed a copy of the completed submission when you click Submit.