WRTS SOMERVILLE Rockin' Friends (During School Holidays) Program July 2026

WRTS SOMERVILLE Rockin' Friends Program EOI JULY 2026

Expression of Interest |Preferences Agreement | Health Form | Waiver
Parent/Carer's Name:

First NameLast Name
Phone Number
Email
example@example.com
Email address that Invoices should be forwarded to:
example@example.com
Participant's One (1) Name

First NameLast Name
Participant One (1) Date of Birth

DayMonthYear
Date
Participant One (1) NDIS Number
How is your NDIS Funding for WRTS Services Managed
CHILD 1 - NDIS PLAN END DATE FOR CURRENT QUARTER (if applicable)

MonthDayYear
Date
Please tick the level of support your child requires at the Kids Gym (note: we will let you know if we believe your child requires a higher level of support than you have selected)
Has this child attended a WRTS Somerville Group Session before?
Participant Two (2) Name (insert sibling's details if relevant)

First NameLast Name
Participant Two (2)Date of Birth

DayMonthYear
Date
Participant Two (2) NDIS Number
How is your NDIS Funding for WRTS Services Managed
CHILD 2 - NDIS PLAN END DATE FOR CURRENT QUARTER (if applicable)

MonthDayYear
Date
Please tick the level of support the second child requires at the Kids Gym (note: we will let you know if we believe your child requires a higher level of support than you have selected)
Has the second child attended a WRTS Somerville Group Session before?
I am aware that before WRTS will confirm enrolments for Excursion days, my child/ren are required to attend on 2 seperate occasions (a) Rockin'Friend's Groups during school term, and or (b) Holiday Program full or half days
WEEK ONE
Monday 29 June 2026 | AM: TBC| PM: TBC (Select the time)
TUESDAY 30 June 2026 | AM: TBC | PM: TBC(Select the time)
WEDNESDAY 1 July 2026 | EXCURSION | TBC + GYM ACTIVITY| ART/CRAFT - TBC (Select the time)
Aqua Park is located just off the Mornington Peninsula Freeway at Bangholme (Patterson Lakes) | Bounce, slide and splash your way over the bridges, down the slides, onto the trampoline and through the barrel of doom. With over 300m of course, children will be entertained for hours! | All participants must have basic swimming skills | Lifejacket must be worn at all times | We will staff 1:3 or 1:2 or 1:1 as required and plan to have staff positioned at various points along the course to ensure all children are in our sights and within our reach at all times.
Aqua Park excursion staff:child ratios
THURSDAY 2 July 2026 | AM: TBC | PM: TBC (Select the time)
FRIDAY 3 July 2026 | EXCURSION | TBC + GYM ACTIVITY| ART/CRAFT - TBC(Select the time)
Notes if required:
WEEK TWO
MONDAY 6 July 2026 | AM: TBC PM: TBC (Select the time)
TUESDAY 7 July 2026 | EXCURSION | TBC + GYM ACTIVITY| ART/CRAFT - TBC (Select the time)
WEDNESDAY 8 July 2026 | EXCURSION | TBC + GYM ACTIVITY| ART/CRAFT - TBC (Select the time)
THURSDAY 8 July 2026 | AM: TBC| PM: TBC (Select the time)
FRIDAY 9 July 2026 | EXCURSION | TBC + GYM ACTIVITY| TBC (Select the time)
Notes if required:
MONDAY 12 January 2026 | AM: ACTIVE - Obstacle Course| PM: Tissue Paper Art (Select the time)
TUESDAY 13 January 2026 | EXCURSION - Chocolate Factory Mornington Peninsula
WEDNESDAY 14 January 2026 | AM: Sensory - Foam| PM: Cooking - No Bake Monster Cookie Balls (Select the time)
THURSDAY 15 January 2026 | EXCURSION - Hillview Playground Reserve Dromana
FRIDAY 16 January 2026 | AM: ART - Pour Paint Canvas| PM: ACTIVE - Scavanger Hunt (Select the time)
Notes if required:
MONDAY 19 January 2025 | EXCURSION - The Big Goose
TUESDAY 20 January 2025 |AM: Cooking - Bush Donuts| PM: Rainbow Scratch Art (Select the time)
WEDNESDAY 21 January 2025 |EXCURSION - Museum of Art & Play (MOPA)
THURSDAY 22 January 2025 |AM: We Rock Indoor Bowling| PM: Mismatch of Art Activities (Select the time)
FRIDAY 23 January 2025 |AM: Sensory - Slime| PM: Cooking - Pizza (Sweet & Savoury) (Select the time)
Notes if required:
COMPANION CARD: If your child has a Companion Card, please upload a photo of the card here. To apply for a Companion Card visit https://www.companioncard.vic.gov.au/how-apply
Upload a copy of your Companion Card (if applicable)

Cancelof
MEDICATION My child(ren) will require Medication to be administered by WRTS SOMERVILLE during School Holiday Sessions:
Does your child suffer from any known allergies?
DIETARY REQUIREMENTS & ALLERGIES Some activities have a food element to them. Does your child have any allergies/intolerances? If so, please provide details.
If YES then please describe Allergy, Reaction and treatment (note if your child is Anaphylaxis we will require a Medical Management Plan and the Epi-pen will need to be brought to each session)
Please list interest or things your child likes doing
Please list things that motivate or ways your child might be encouraged to participate
Is your child toilet trained? Details if required.
What is your child's preferred model of communication?
Does your child have physical limitations we should be aware of?
Are they any behaviour or safety concerns that we should be aware of to help your child have a great time?
If Yes please provide details:
Upload a copy of your child's Behaviour Support Plan

Cancelof
Do you have any concerns about your child absconding from the Gym or during excursions?
Has this happened before when your child was with you or in the care of others?
If Yes please provide details:
I have reviewed the program of activities of WRTS and feel that my child can participate with the following restrictions/adaptions/supports.
BEHAVIOUR CONCERNS: I understand that WRTS Management reserves the right to terminate services at any time due to behaviour concerns that may adversely impact the other children and staff of WRTS. I will be advised verbally and in writing.
EXCURSIONS : I am aware that WRTS Management may determine that it is NOT appropriate for my child to attend Excursions away from the Gym. This decision will be made based on observations of my child as they participate in the program. If my child cannot attend the excursion I understand that I will have the choice to (a) cancel care for that day (at no cost) or (b) have my child at the Gym and that fees will be charged based on the staff:child ratio remaining at the gym (this may mean that my fees are for 1:1 support on this day/s) or (c) attend the excursion with my child
HOLIDAY PROGRAM BOOKING CONDITIONS

I understand that by submitting this EOI Form, I am confirming my interest for We Rock the Spectrum - Somerville's School Holiday Program for the days and programs I have indicated above.

I understand that by submitting this Expression of Interest Form, I will be allocated as many sessions as possible, according to my wishes. I will receive a Booking Confirmation email outlining these sessions.

After my participant receives the services, I will be charged for each session.

I understand that We Rock the Spectrum Kids Gyms are NOT Licensed Childcare facilities. Government Fee assistance is NOT available.

I understand that this EOI form will serve as a Service Agreement for the WRTS Somerville June/July 2026 School Holiday Program.

I understand that I need to have completed a Service Agreement & Schedule of Supports to enable WRTS to invoice for NDIS funds to cover this program via the below link:

https://form.jotform.com/242047452629862
MEDIA CONSENT We occasionally post photos from the day on our Instagram and Facebook page to show the daily activities. No names are listed. Are you ok for your child’s image to be posted?
NDIS GROUP PRICING GUIDELINE:I understand that NDIS Pricing Guidelines require WRTS to outline our costs in our invoicing and separate out fees for Support hours, Gym Capital Costs, Non Face to Face Planning time and Travel Costs (where required). These line items will be outlined on Invoices. These changes may in some cases alter the prices slightly. LACs, Plan Managers and Support Coords will be expecting these changes.

Other
OUT-OF-POCKET (OP) FEE: I understand that Excursions may incur an out-of-pocket fee to cover excursion activities and costs that the NDIS do not cover eg. Entry tickets. Each Excursion Out of Pocket (OP) Fee will vary and is indicated on the program's flyer. The Out of Pocket (OP) charge will be invoiced separately and must be paid personally, in a timely manner. The Out of Pocket (OP) Fee adheres to the same cancellation policy as detailed below.
CANCELLATION POLICY: I am aware of and agree to adhere to WRTS Australia's Cancellation Policy, as outlined below and agree to adhere to its terms.

Fees for April 2026 Program are as follows and are based on the level of support your child requires:

	1:3 Support	1:2 Support	1:1 Support
3 Hrs	$131.18	$166.30	$271.64
6.5 Hrs	$222.78	$298.86	$527.11
7 Hrs	$235.86	$317.80	$563.60
8 Hrs	$262.03	$355.67	$636.59

NOTE:

Excursion fees will vary as a share of $1 per KM travel fee is added

Excursion Out of Pocket (OP) Fees apply for costs not covered by NDIS and will be invoiced directly to the parents for payment.

Excursion	Out Of Pocket Cost*
Melbourne Cable Park - Aqua Park	$45
Sailability	$5
Flip out Knox	$25
Diamond Valley Railway	$10
Myuna Farm	$15

*Includes a share of the cost for staff entry

Fees will be a different for children who required 1:1 during Excursions and then 1:2 or 1:3 when in Gym

Anything else you would like us to know:
In consideration of being permitted by We Rock the Spectrum Kid’s Gym (hereinafter “WRTS”) to participate in its activities and to use its equipmentand facilities, now and in the future, I as parent or legal guardian of the child/ren [named at the bottom of this document] a minor (hereinafter “Minor”),hereby grant the permission necessary to allow Minor to participate in all activities at this WRTS location and agree with all the terms of this Releaseof Liability, Indemnity Agreement, and Assumption of Risk Agreement (hereinafter “Agreement”). I, in my own behalf and on behalf of Minor,further agree to release, indemnify and discharge WRTS, its agents, owners, shareholders, directors, partners, employees, volunteers,manufacturers, participants, lessors, affiliates, its subsidiaries, related and affiliated entities, successors and assigns (hereinafter “Released Parties”),on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

I understand and acknowledge that the activity the Minor is about to voluntarily engage in as a participant bears certain known risks and unanticipated risks which could result in physical, emotional, or mental injury, paralysis, illness or disease, death, or damage to Minor, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activities at WRTS. The risks include, among other things: Use of WRTS equipment entail certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Use of equipment may expose participants to the usual risk of cuts, scrapes, bruises, and rug burns. Other more serious risks exist as well. Participants may fall off equipment, sprain, injure, or break fingers, toes, wrists, feet, legs, back, or neck, and can suffer more serious bodily injuries as well. In any event, if Minor is injured and may require medical assistance, you as parent or legal guardian will assume full liability and responsibility for the expenses.Furthermore, WRTS employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They may give incomplete warnings or instructions, and the equipment being used might become loose, out of adjustment, or malfunction. There is also a risk that WRTS employees may be negligent in, among other things, monitoring and supervising use of its equipment and facilities and in the maintenance and repair of its equipment and facilities.I expressly agree that this Agreement is governed by the State of Victoria, Australia and is intended to be as broad and inclusive as permitted by Victorian and Australian law, and that in the event any portion of this Agreement is determined to be invalid, illegal, or unenforceable, the validity, legality and enforceability of the balance of the Agreement shall not be affected or impaired in any way and shall continue in full legal force and effect. In the event that I file a lawsuit against WRTS, I agree to do so solely in the State of Victoria, Australia and I further agree that the substantive law of the State of Victoria, Australia shall apply in that action without regard to the conflict of the law rules of that state.I further agree to defend, indemnify and hold harmless WRTS from any and all claims or lawsuits for personal injury, property damage or otherwise which are brought by, or on behalf of the Minor, and which are in any way connected with such use or participation by the Minor, including injuries or damages caused by the negligence of Released Parties, except injuries or damages caused by the sole negligence or wilful misconduct of the party seeking indemnity.I agree to grant WRTS and all Related Parties, the irrevocable right and permission to photograph and/or record me or Minor in connection with WRTS to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner in any and all media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of the photograph and/or recording and acknowledge and agree that the rights granted to this release are without compensation of any kind. All photographs and/or recordings are exclusive to WRTS.By signing this Agreement, I acknowledge that I have had sufficient opportunity to read this entire Agreement, I understand it completely, I understand that it affects my legal rights, and I agree to be bound by its terms. I also agree if anyone is hurt or property damaged during the Minor’s participation in this activity, I may be found by a court of law to have waived my or the Minor participant’s right to maintain a lawsuit against WRTS and the Released Parties on the basis of any claim from which I have released them herein.
By Signing this I agree to all Booking Conditions stated above: (PLEASE ENSURE YOU PRESS SUBMIT WHEN FINISHED)
Agreement Date

DayMonthYear
Date
Should be Empty:

WRTS SOMERVILLE Rockin' Friends Program EOI JULY 2026