SERVICES CONSENT FORM

Wonderland Community Services

Services Consent Form
Site

Wonderland Retreat (TASMANIA)Pirates Rest (QUEENSLAND)
Participants Name*

First NameLast Name
D.O.B of Participant
Participants Current Address*

Street Address

Street Address Line 2

CityState

Post Code
Who gives consents for the participant

Self (Participant)Parent if under 18Nominated guardianPublic Guardian
Name of Guardian

First NameLast Name
Phone of Guardian
Please enter a valid phone number.
Email of Guardian
example@example.com
I give my consent for Wonderland Community Services to make contact with the following services (if required) to obtain and share information for my safety and support including information regarding available finances to support proposed services.
- Emergency Services 000
- NDIS Commission
- General Practitioner (GP)
- Medical Specialists
- Allied Health Professionals
- Behaviour Support Practitioner
- Education Provider
- Coordinator of Support or LAC
- Public Guardian
- Public Trustee
- Health & Mental Health Services
- Specified family or informal supports
- Plan Managers
- State Authorities
Identify close contacts name and phone numbers*
People/ services I do not give consent for Wonderland to make contact with out of the above list:

I agree to the following

	Yes
1. Sharing (obtaining and releasing) personal information to the above agreed supports if necessary. Including consent to share care plan with support workers and nominated stakeholders.
2. Safety Risk Assessments as required
3. Medication Administration as required and under doctor's orders including medications for the purpose of managing behaviours
4. Transport as requested or in emergencies
5. Photo or video taken for advertising and social media
6. Photo or video taken to share with parents/caregivers. Including sharing of photos on our internal communication systems
7. To seek up-to-date medical/health information (including Dietary management requirements) and sharing these with Wonderland Community Services
8. To take pictures of valuables and personal items as a record to ensure safe return of valuables
9. To allow access to my NDIS Plan goals including funding support information
10. If I have identified the need for Behaviour Support I agree for Wonderland Professionals to provide assessment and a report which may include Restrictive Practices. I understand that I will be consulted in this process and that regular reviews will take place to ensure my rights are protected.
11. To participate in and be contacted for upcoming external Audits
12. To contact my COS or the Plan Manager to obtain my current funding information, if required for me to be able to access the services of my choice - i.e. is there enough in my budget to engage in a nominated service
13. Data storage of personal information on Monday.com platform (password protected) stored on servers in the US and subject to binding contracts for protection of personal information.
14. I understand that Wonderland Community Services may be required to release my confidential information which is required or authorised by law with or without my permission.
15. I understand that should I require a Positive Behaviour Support Plan, that myself and/or my guardian will be involved in the process of obtaining and completing.

I understand that I can withdraw consents at any time and will complete a new Consents Form which will be updated on my confidential file/care plan when received.
Activities Consent

Participant participation in organised activities lead by Wonderland Retreat and Pirates Rest

Please indicate your consent for the following activities

	Consent - Agree	Do not Consent
Swimming - beach or onsite
Horse Riding (TPP)
Animal Activities - onsite
Bike/billy cart riding
4 wheel driving (TPP)
Golf/mini golf (TPP)
Movies for Mature Audiences
Laser Tag (TPP)
Archery - (TPP)
Hiking/bushwalking
Visit to caves (TPP)
Trampoline onsite
Fast Food
Indoor Parks (TPP)
Rock climbing
Ball games
Remote controlled cars
Boat cruises/paddleboating (TPP)
Kayaking (TPP)
Zoos (TPP)
Ropes courses/ziplining (TPP)
Swimming (TPP)
Trampoline (TPP)
Sailing (TPP)

I waive any right to seek costs against Wonderland and its Directors and Employees for the above-agreed activities provided by third party external providers. (TPP)
Participant /Guardian signing this form:*

First NameLast Name
Date*

DayMonthYear
Date
Signature*

Clear
WCS warrants that personal information obtained will be stored securely on MONDAY.COM and will only be used to provide support for participants and will not be shared with unauthorised third parties.
Should be Empty:

Wonderland Community Services

Activities Consent