June/July 2020 School Holiday Social Skills Telehealth Program Registration Form

Form Completed By: *

Name

Relationship to Child: *

Date: *

Date

Mobile: *

Email: *

example@example.com

Child's Full Name: *

Child's Date of Birth: *

I/We would like our child to participate in the School Holiday Social Skills Program run by Melbourne Child Development. I/We agree to pay an administration fee of $181, to secure our place in the program. *

Yes No

This fee is for setting up the file and co-ordinating the Program.

This administration fee will be deducted from the cost of the Program. This administration fee is not refundable unless Melbourne Child Development are unable to offer you a place in the Program. Please read the Program Terms and Conditions below for more information.

PROGRAM COST:

Pre-Program Assessment – 60 minutes

(for new clients/clients that haven’t had therapy at MCD in the past 18 months)

$272 (Monday-Friday) $286 (Saturdays)

4 x 60-minute small group / dyad sessions

$181 per session, OR

4 x 45-minute individual sessions

$206 per session

Availability of small group or dyad sessions is dependent on children being suitably matched. If no suitable match can be found, we will offer individual sessions for your child.

PROGRAMS RUNNING THIS SCHOOL HOLIDAYS:

Making Playmates

Suitable for preschool aged children (3-5 years of age)

Introduction to foundational social thinking and behaviour skills drawing on the ‘We Thinkers’ social thinking program.

Building Buddies

Suitable for children 5-7 years of age

Follow on from Making Playmates, building on foundational social thinking and behaviour skills, drawing on the ‘We Thinkers’ social thinking program.

Hanging Out

Suitable for children 7-11 years of age

Evidence-based ‘Social Communication Intervention Program’ for promoting pragmatic language skills in middle to upper primary school aged children.

SAS Cadet - Mission: Recharge!

Suitable for children 9 - 15 years of age

Cadets who have already completed the Secret Agent Society Program within the last two years and want to top-up their toolkit.

FUNDING AND REBATE OPTIONS FOR THE TELEHEALTH SCHOOL HOLIDAY PROGRAM:

Helping Children with Autism and Better Start for Children with a Disability (FaHCSIA)

Children who are registered under this funding may use it for these sessions.

Medicare – Chronic Disease Management Plan (CDMP) (previously named EPC – Enhanced Primary Care Plan)

Your General Practitioner is the person who determines whether your child qualifies for this program.

These Medicare rebated session can only be used for individual therapy sessions and will therefore only apply to the pre-program assessment and individual sessions, but not group or dyad sessions.

Medicare – Helping Children with Autism and Better Start for Children with a Disability

Your Paediatrician/Psychiatrist/General Practitioner (GP only for Better Start for Children with a Disability) is the person who will determine if your child is eligible for this program.

These Medicare rebated session can only be used for individual therapy sessions and will therefore only apply to the pre-program assessment and individual sessions, but not group or dyad sessions.

Private Health Insurance

Check with your Private Health insurer to see if you are covered for Speech Pathology/Occupational Therapy sessions and/or Speech Pathology/Occupational Therapy Group sessions in your extras cover.

NDIS

Children who are registered under this funding program may be able to use it for these sessions. Please check your plan, and if necessary discuss with your plan manager if there will be any out of pocket expenses (e.g. Third-party managed plans).

Please note that Melbourne Child Development has decided not to become a registered NDIS provider – those with an NDIA managed plan will need to seek an NDIS registered provider.

CANCELLATION POLICY:

If you cannot attend a session, please provide a minimum of two business days notice. If less than two business days notice is provided, a fee of 50% of the cost of the session will be charged. Cancellation fees are usually the responsibility of the parent/carer as most funding and rebate programs do not cover these.

I have read Melbourne Child Development's cancellation policy and understand and accept that I must provide a minimum of two business days notice if we cannot attend a session and if I provide less than 2 business days notice I will be charged a fee of 50% of the cost of the session. *

Yes No

PROGRAM TERMS AND CONDITIONS:

Enrolment to this program requires commitment to all four sessions.
An administration fee of $181 is required to enrol in the program for administration costs. This fee is non-refundable* and will be taken off the cost of the first session.
A cancellation fee of 50% of the per session cost will apply if cancelled within 24 hours of the session time. Cancellation fees are usually the responsibility of the parent/carer as most funding and rebate programs do not cover these.

*Should Melbourne Child Development be unable to offer you a place in the School Holiday Social Skills Program, any administration fee paid will be refunded.

Please select the Program you wish your child to join: *

Please select your preferred mode of delivery: *

Small group / dyad Individual

Any other comments regarding availability:

We will do our best to accommodate your request.

Please select your availabilities: Sessions are available between the hours of 10am and 2:30pm during both weeks of the School Holidays, and run over four consecutive days, either Monday-Thursday or Tuesday-Friday. Please select your preferred week. *

Week 1: Monday 29th June - Friday 3rd July Week 2: Monday 6th July - Friday 10th July Available either week

ADMINISTRATION FEE PAYMENT: (Receipt with full billing information will be emailed to you within two business days)

Administration Fee - June/July 2020 Telehealth School Holidays Social Skills Program

$ 181.00 AUD

Total

$ 0.00 AUD

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