Additional Services Request Form-0001B Logo
  • ADDITIONAL SERVICES REQUEST (Form-0001B)

  • Resident's Details

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  • Skymac can offer you a range of services outside of what is included in your fortnightly rent/board.

    These services are listed below, and it is important to note that they are not included in your board and lodging (rent). If you would like Skymac to provide you with any of these additional services, you will need to let us know by completing the following checklist.

    You need to indicate how you will be paying for these services and we can provide you with a price list of our services to help you make your decision.

  • SERVICES

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  • By signing below, you acknowledge that the services listed above are not included on your R18 rooming agreement and are not included in the rent you pay.

    You also agree to pay for your above chosen services as you have indicated. You also acknowledge Skymac’s duty of care and agree to be bound by the house rules provided with your R18, and that you understand failure to do this may result in your request being denied.

    You also understand that you can amend or terminate this request at any time and seek the assistance of an external service provider if you wish.

  • Signature of Resident

    *Or signature of person acting on authority under Guardianship Administration Act 2000 or Powers of Attorney Act 1998 for the person named above, OR an Informal Decision Maker (must have an Informal Decision Maker Details Form-0071 signed) for the person named above.
  • Clear
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  • In the presence of (Witness)

  • Clear
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  • Should be Empty: