Language
  • English (Australia)
  • Chinese
  • Indonesian
  • Hindi
  • Arabic‬‎
  • Filipino
  • PLEASE SEND ME TO
  • PARTICIPANT SUPPORT PLANNER

    PLEASE FILL IN ALL SECTIONS TO ASSIST US IN DEVELOPING YOUR PERSON CENTRED SUPPORT PLAN
  • Date
     - -
  • Format: (000) 000-0000.
  • How is plan managed
  • The support Im requesting is
  • Format: (000) 000-0000.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • I need assistance with
  • SUBMIT IF DONE OR NEXT TO FILL IN OTHER DOCUMENTATION

  • CONSENT FORM - RELEASE OF INFORMATION AND SERVICES

    THIS IS A LEGAL DOCUMENT
  • I (individual/legal guardian or person responsible) of
    give consent for Rogue Industries and Kaia Care to exchange information about me which is relevant and necessary for the service/s to be provided for the purpose of: 

  • CONSENT FOR USE OF RESTRICTED PRACTICE

  • Name         
    Please select one of the following
    r           
    give consent for the following restrictive practices. I understand that I have the right to review/withdraw consent. I have been informed of the practices and rationales for each practice proposed for Participant         This consent will expire in 12 months from the signed date unless notified otherwise.
    Practice Chemical Restraint:     
    Practice Environmental Restraint:      
    Kaia Care adheres to the Australian Privacy Principles (2012) and has a Privacy Policy in place to keep your information safe. Personal information collected or received will be used, stored and disposed of. Please request the full Privacy Policy
    from the Manager.

  • SERVICE AGREEMENT

  • ROGUE INDUSTRIES

    ROGUE INDUSTRIES

    DAY PROGRAM GROUPS, 1:1 SUPPORT, SOCIAL INCLUSION, SUPPORTED HOLIDAYS, 4WD EXPERIENCES, STA, RESPITE
  • DOB
     - -
  • Table of Contents 


    1. Introduction 

    2. Parties 

    3. Term 

    4. Services 

    5. Cost and Payment Terms 

    6. Changes to the Agreement 

    7. Rights and Responsibilities of the Parties 

    8. Cancellation Policy and Additional Services 

    9. Dispute Resolution 

    10. Suspension of the Agreement 

    11. Termination of the Agreement 

    12. Miscellaneous 

    13. Quotation 

    14. Agreement Signatures

     

    1. Introduction 


    1.1 The Agreement outlines: 

    i. The Parties to the Agreement; 

    ii. The Term of the Agreement; 

    iii. The Services to be provided under the Agreement; 

    iv. Payment for the Services; 

    v. How the Services and the Agreement may be varied; 

    vi. The rights and responsibilities of the Parties; 

    vii. How disputes between the Parties are to be resolved; and 

    viii. How and when the Agreement will end. 


    2. Parties 


    2.1 The Agreement is made between: 

    (a) ROGUE INDUSTRIES, ABN - 35658054043 

    (b) (“the Participant”); or 

    (c) (“the Participant’s Representative”). 

    2.2 The Agreement may only be executed on behalf of the Participant by the Participant’s Representative if the Participant does not have capacity to enter into the Agreement. 

  • 3.1

  • Agreement will commence on

  • Date
     - -
  • Agreement will end on

  • Date
     - -
  • 3.2 The Term may be ended earlier in accordance with clause 11 of the Agreement.


    3.3 If the Term of the Agreement ends and the Participant continues to receive the Services from ROGUE INDUSTRIES, the Parties agree that the Services are provided on the same terms and conditions as the Agreement which shall remain in full force and effect until such time as the Parties enter into a further Agreement for the provision of Services. 

     

    4. Services 


    4.1 The Services which ROGUE INDUSTRIES agree to provide to the Participant under the Agreement are set out in the Service Summary (Quote) annexed to the Agreement, this is flexible at the discretion of the participant and participant’s representatives request. 


    5. Cost and Payment Terms 


    5.1 The cost of the Services which ROGUE INDUSTRIES agrees to provide to the Participant under the Agreement is set out in the Quote. 

    5.2 ROGUE INDUSTRIES will send an invoice to the Participant/ Participants plan manager for the Services within 7 days after the Services are provided to the Participant. 

    5.3 The Participant agrees to pay ROGUE INDUSTRIES for the Services within seven 

    (7) days of the date of ROGUE INDUSTRIES invoice; or, 

    5.4 The Participant acknowledges and agrees that ROGUE INDUSTRIES may claim payment for the Services from the Plan Nominee within 7 days after the Services are provided to the Participant; or, 

    5.5 The Participant agrees to inform ROGUE INDUSTRIES of any changes to the management of the funding for any of the Services provided under the Agreement which will affect the method of payment for the Services 

    5.6 If the Cost of the Services or the amount of funding available for any of the Services appearing in the Quote is increased during the Term, the Parties agree that ROGUE INDUSTRIES will be entitled to amend the Quote to reflect the increase in the Cost and to immediately charge the increased Cost for the Services in full. 

    5.7 The Participant agrees to be personally liable to ROGUE INDUSTRIES for the Cost of the Services if the Participant has overspent their NDIA funds. 

    5.8 The Cost for the Services is expressed as being inclusive of GST 

    6. Changes to the Agreement 


    6.1 ROGUE INDUSTRIES may, in its absolute discretion, make changes to the Agreement where it considers such changes to be desirable or necessary, With the consent and in agreement of the participant / Participants representative. 

    6.2 Without limiting clause 6.1 (above), the Parties agree to change the Agreement immediately upon the occurrence of any of the following events: 

    i. The NDIA changes the NDIS arrangements, including the regulated prices for the Services, Fee Schedules and definitions of supports; 

    ii. Changes are required in the delivery of the Services which affect the Agreement; 

    iii. The needs, goals, or circumstances of the Participant change, or are clarified after the Agreement commences, including but not limited to changes to the Services required because of the Participant’s support needs change and 

    iv. Where the Parties otherwise agree that changes to the Services or their delivery are required. 


    7. Rights and Responsibilities of the Parties 


    7.1 The Participant agrees to: 

    i. Treat staff, other Participants and members of the public with courtesy and respect when receiving the Services; 

    ii. Provide with a timely understanding of the Participant’s support needs ROGUE INDUSTRIES and any relevant supporting plans and / or documentation (e.g., behavior support plans) prior to commencement and during the provision of services; 


    iii. Inform ROGUE INDUSTRIES about any changes to the Participant’s personal details; 

    iv. Inform ROGUE INDUSTRIES about any changes to the Participant’s health that may impact upon ROGUE INDUSTRIES and its ability to provide the Services; 


    v. Inform ROGUE INDUSTRIES about any changes to the Participant’s support needs that may impact upon ROGUE INDUSTRIES and its ability to provide the Services; 

    vi. Maintain a current Agreement with ROGUE INDUSTRIES in order to receive the Services; and 

    vii. Provide a safe working environment for ROGUE INDUSTRIES staff when they are working in the Participant’s home or at a location selected by the Participant in which to receive the Services; 

    7.2 ROGUE INDUSTRIES agrees to: 

    i. Treat the Participant and the Participant’s Representative with courtesy and respect; ii. Provide the Services set out in the Quote in accordance with the Agreement; iii. Protect the Participant’s privacy and confidential information; 

    iv. Provide information to the Participant with respect to the cost of additional services not included in the Quote, but which are necessary to meet the Participant’s goals, e.g., the cost of entrance fees, event tickets and meals; 

    v. Communicate openly and honestly with the Participant and seek to respond to feedback and complaints in a timely manner in accordance with the terms of the Agreement; 

    vi. Consult the Participant about decisions on how Services are provided; 

    vii. Provide the Participant with a minimum of twenty-four (24) hours’ notice if ROGUE INDUSTRIES needs to change a scheduled appointment to provide the Services. 

    viii. Keep accurate records of the support provided to the Participant. 


    8. Cancellation Policy and Additional Services 


    8.1 The Participant must provide ROGUE INDUSTRIES with a minimum of twenty-four 

    (24) hours’ notice if they wish to cancel a scheduled Service. 

    8.2 If the Participant provides ROGUE INDUSTRIES with the notice required at clause 8.1, ROGUE INDUSTRIES will not charge the Participant for the scheduled Service or allied health appointment. 

    8.3 If the Participant does not provide ROGUE INDUSTRIES with notice of cancellation before 3pm on the day before the scheduled Service ROGUE INDUSTRIES will charge the Participant for 90% of the cost of the scheduled Service. 

    8.4 If the Participant will not require the Services for an extended period of time, the Participant agrees to give ROGUE INDUSTRIES one (1) months’ 

    written notice that they will not require the Services, specifying the start and end date during which they will not require the Services. 

    8.5 ROGUE INDUSTRIES may, but is not obliged to, provide additional services to the Participant if the Participant provides ROGUE INDUSTRIES with the notice required at clause 9.1 (“the Additional Services”). 

    8.6 If ROGUE INDUSTRIES agree to provide the Additional Services, the Participant acknowledges and agrees that the Cost of the Additional Services is not to exceed the Cost of the Services as set out in the Quote. 


    9. Dispute Resolution 


    9.1 The Participant should direct the Dispute directly to 

    ● Roimata Marsh roi@teamrogue.com.au 0435122121 

     

    10. Suspension of the Agreement 


    10.1 ROGUE INDUSTRIES may suspend the Agreement with immediate effect if: 

    i. The Participant commits a serious breach of the Agreement; or 

    ii. The Participant’s NDIS plan is suspended or replaced by a new NDIS plan. 


    11. Termination of the Agreement 


    11.1 Should either Party wish to end the Agreement, they must provide at least fourteen (14) days’ written notice of their intention to end the Agreement to the other party and at the expiry of 

    this notice the Agreement shall be at an end. Any outstanding fees are to be paid by the end of this notice period. 

    11.2 ROGUE INDUSTRIES may terminate the Agreement without notice and with immediate effect if: 

    i. The Participant commits a serious breach of the Agreement, including a failure to pay for the Services; 

    ii. The Participant’s NDIS plan is suspended or replaced by a new NDIS plan; or iii. the Participant stops being a participant in the NDIS 


    12. Miscellaneous 


    12.1 The Agreement contains the entire agreement between the Parties with respect to the Services and supersedes and replaces all prior representations and agreements, whether oral or in writing, with respect to the Services. 

  • 13. Quotation will already be supplied to you with relevant dates before signing this agreement

     

    14. Agreement Signatures

  • Date
     - -
  • Should be Empty: