Cliq Connection
Sign-Up Form

$315 — NDIS funded

Sign up for Cliq Connection Learning

Fill in the details below and we'll get everything set up for you.
Login details will be sent to your email within 2 business days.

4 online safety modules

12 months full app access

Unlimited messaging included

Self & plan managed only

Participant details

First name *

Last name *

Date of birth * Must be 18 or over

Gender *

Mobile * Verification code sent here

Email * Login details sent here

State *

Suburb *

NDIS details

NDIS number *

Funding type *

Eligible funding line *

Invoice email If different to participant email

Plan manager details

Plan manager name

Plan manager email

Additional contact

Optional — support worker, support coordinator or family member

Contact name

Relationship to participant

Contact phone

Contact email

One last thing

How did you hear about us? *

Service agreement

By submitting this form you agree to our Cliq Connection Service Agreement. We will invoice your plan manager for Cliq Connection Learning at $315 for 12 months of access to the learning modules and the Cliq Connection app. We are not NDIA registered and are unable to accept NDIA managed funding.

I have read and agree to the Cliq Connection Service Agreement. *

Cliq Connection Sign-Up Form

Sign up for Cliq Connection Learning

Cliq Connection
Sign-Up Form