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Becoming a Member

HOW do I become a member?

To become a member your child needs to be aged between birth and 18 years and to be undergoing a recognised home based therapy program. Check out the links to some of the NDTP that we proudly support here.

As a member of BICT you join an amazing family of parents who have a child with Brain Injury.
To qualify you need to be a New Zealand resident.

WHAT do you need to do?

Complete the following form below.
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Parents / Caregivers Name

Member Information

Child's Name
Address
Home Based Neuro-Developmental Therapy Program (NDTP) you are currently following:
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How would you describe your national Identity:

Please attach the following documents and pay the annual subscription fee. If your files fail to load, please send them directly to [email protected]

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Emailed photo acceptable
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From your social worker, doctor, needs assessment person or disability organisation
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Annual Membership Fee
$0.00

CONSENT FOR USE OF IMAGE/LIFE STORY

I hereby voluntarily provide consent for Brain Injured Children Trust to use information in relation to myself and my children under the age of 18 years of age for their promotional purposes. This consent includes using my own and my children’s photographs, life stories, statements and video and digital images for the following purposes:

  • To be included in newsletters of Brain Injured Children Trust.
  • to be included in brochures and promotional material of Brain Injured Children Trust and Neuro Developmental Therapy Program.
  • To be included on the Brain Injured Children Trust website.
  • Other promotional material.
Consent Choice

RELEASE OF DETAILS FOR REFERRAL

I hereby provide consent for Brain Injured Children Trust to provide my information in relation to myself and my children under the age of 18 years to other relevant organisations and families.

This information will be used to refer my family to organisations for services and support.
This information will be used to refer my family to other families who are members of Brain Injured Children Trust for services and support.
This information will be used to refer my family to other families who are enquiring into the services and support of Brain Injured Children Trust and the Neuro Developmental Therapy Programs.
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