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Seniors Social Attendance Form
July & August & September Program 2024
22
Questions
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1
Are you a registered Participant of Isabella Able NDIS Support Services?
YES
NO. SIGN UP!
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2
Please confirm that you are one of the following:
*
This field is required.
Person filling in this form
I am the Participant
I am the Participant's NDIS Nominee
I am the Participant's Support Coordinator
Other
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3
Full Name:
*
This field is required.
Details of the person filling in this form
First Name
Last Name
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4
NDIS Nominee/Participant's Email
*
This field is required.
This is where the copy of this form will be sent
example@example.com
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5
Full name of the Participant attending program
*
This field is required.
First Name
Last Name
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6
Select your program of support activities
*
This field is required.
Click on the picture to select the activity you wish to attend. Remember to choose as many as you wish!
ARTS & CRAFT - Tuesday 2nd July 2024 - 9.30am to 2pm
GREECE SHOW -Saturday 13th July 2024 -6pm to 11pm
FYNSFORD MORNING MELODIES - Tuesday 16th July 2024 -9.30am to 2.30pm
BINGO -Saturday 27th July 2024 -10am to 3pm
SPHINX MORNING MELODIES -Wednesday 31st July 2024 - 9.30am to 2.30pm
BEAUTY & THE BEAST SHOW- Saturday 3rd August 2024 5pm to 11.30pm
ARTS & CRAFT - Tuesday 6th August 2024 - 9.30am to 2.30pm
BALLARAT GARDENS & PIZZAHUT - Saturday 17th August 202410am to 3pm
FYNSFORD MORNING MELODIES - Tuesday 20th August 2024 -9.30am to 2.40pm
SPHINX MORNING MELODIES - Wednesday 28th August 2024 - 9.30am to 2.30pm
ARTS & CRAFT- Tuesday 3rd September 2024 - 10am to 2pm
JIMEOIN COMEDY SHOW - Saturday 7th September 2024 5pm to 11pm
FYNSFORD MORNING MELODIES - Tuesday 17th September 2024 -9.30am to 2.30pm
WERRIBEE SHOPPING TRIP - Saturday 21st September 2024- 10am to 3pm
SPHINX MORNING MELODIES - Wednesday 25th September 2024 - 9.30am to 2.30pm
AFL FINALS & FOOD - Saturday 28th September 2024 -2pm to 9pm
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7
I acknowledge that I am making this reservation in advance to secure my spot, as tickets and/or accommodations need to be pre-booked and I will be billed for these costs.
YES - I understand
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8
Activity & Program Expenses
*
This field is required.
Please choose the option that you prefer:
YES - I would like to have the activities and any expenses incurred with the program covered by the participant's NDIS plan.
NO - I do not want the activities and any expenses incurred with the program to be covered by the participant's NDIS plan. The responsibility for covering the program costs and expenses will lie with the Participant/Participants nominee.
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9
Activity Costs - Please confirm that you agree to the following:
*
This field is required.
YES- I consent for the program activities and associated expenses to be funded from the participant's NDIS plan.
YES- There is sufficient funding available in the participant's plan to support the program activities and associated costs.
YES- The activities included in the program are aligned with the Participant's NDIS goals.
YES- The program activities facilitate the participant in acquiring skills, fostering independence, building relationships, and exploring new experiences.
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10
I understand that the expenses related to the program, as well as any costs incurred, will be itemised in a separate invoice to clearly distinguish the expenses.
*
This field is required.
Yes
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11
I understand that if the invoice remains unpaid within 30 days of receiving it, the responsibility for covering the activity costs and any associated expenses incurred with the program will fall on the Participant/Participants NDIS Nominee.
*
This field is required.
Yes
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12
Please provide your signature below to indicate your agreement with the program's terms and conditions and the selected activities.
*
This field is required.
Clear
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13
Please share any additional information or details that you would like us to be aware of.
If this question does not apply to you, feel free to skip it.
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14
First up, what should we call you?
Please provide us with your full name
First Name
Last Name
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15
Great! What is your email?
example@example.com
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16
And your phone number please
Please enter a valid phone number.
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17
Does the participant know that you are providing Isabella Able with their details?
*
This field is required.
YES
NO
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18
Please provide us with the Participants full name
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19
What is your relationship with the Participant?
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20
Awesome! So who shall we contact to get them signed up with us?
Please provide full name of the person we will be contacting to join Isabella Able's programs and support
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21
What is their email & number?
example@example.com
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22
Would you like to book in a FREE discovery call?
*
This field is required.
YES
NO
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