Cliq Connection
Sign-Up Form

Once we receive this form we will commence onboarding the user onto the Cliq Connection app. The user will then receive an email with their login details. The participant will need to download the app from the Apple Store or Google Play Store.

The Cliq Connection is a unique online safety education platform designed to help people with disabilities in Australia develop self-awareness, communication, and social skills. It provides structured, regularly updated modules and an app where participants can practice these skills and expend their social circle in a safe environment.

The Cliq Connection app is free of charge we only charge for the education component.

Monthly charge of $38 no lock in contract
Funded from Core Supports in your NDIS plan.

NDIA managed users – please sign up through The Chooze Shop

Referral form and Agreement.

First Name *

Last Name *

Users Mobile Number *

This will need to be available as your verification code will be texted to this number.

Users Email *

This is where verification emails will be sent.

Date of Birth - You must be over 18 years of age to join. *

Identity/Gender *

State *

Suburb *

NDIS Number *

Your NDIS Funding - Are You Self Managed, Plan Managed or NDIA Managed? *

Additional contact

Support worker, Support Coordinator or Family member

Additional contact Phone

Contact's relationship to the user

Additional contact Email

How did you hear about us? *

If you have a Promo code, add it here:

What are you looking for? *

Does the participant have a conviction for Domestic Violence or Sexual Assault? *

What is important to you? *

150 characters

Tell us about yourself *

150 characters

NDIA managed users - sign up through The Chooze Shop.
Referral form and Agreement.

Signature *

Clear Signature

34833

Cliq Connection Sign-Up Form

Cliq Connection
Sign-Up Form