Fitness Care Service Agreement

Fitness Care Sign Up

Service Agreement
Participant Name*

First NameLast Name
Participant or plan nominee email*
example@example.com
Participant NDIS number*
Participant Date of Birth*
Participant or Plan Nominee Phone Number please add name for plan nominee*
Participants phone number.
Confirm Client Residential Address*
Suburb*
Postcode*
Client State*
Please identify any risks *
Please notify us of any risks to yourself or the client
Confirm Participant Availability for fitness sessions or Respite Retreat Date Details*
Please include days and times of availability
Signature

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Should be Empty:

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