WRTS PRESTON CUP WEEKEND GROUPS

Participant's Name*

First NameLast Name

Parent/Carer's Name:*

First NameLast Name

Phone Number*

Email*

example@example.com

Participant's Date of Birth*

Date

One Staff Member to One Child Ratio (1:1 Support)One Staff Member to Four Children Ratio (1:4 Support)1:4 in Gym, 1:1 on Excursions

YESNO (If not, we will be in touch to arrange an induction session)

Second Participant's Name (insert sibling's details if relevant)

First NameLast Name

Date of Birth

Date

One Staff Member to One Child Ratio (1:1 Support)One Staff Member to Four Children Ratio (1:4 Support)1:4 in Gym, 1:1 on Excursions

YESNO (If not, we will be in touch to arrange an induction session)

SATURDAY MORNING IN-GYM SESSION 9AM-12PMI don't want this session

SATURDAY AFTERNOON IN-GYM SESSION 12.30PM - 3.30PMI don't want this session

SUNDAY MORNING IN-GYM SESSION 9.00AM - 12.00PMI don't want this session.

MONDAY AFTERNOON IN-GYM SESSION 12.00PM - 3.00PMI don't want this session.

TUESDAY AFTERNOON IN-GYM SESSION 12.00PM - 3.00PMI don't want this session.

SATURDAY COMBO DAY (GYM/EXCURSION) 9.00AM-3.00PMI don't want this session.

SUNDAY COMBO DAY 10.00AM-4.00PMI don't want this session.

MONDAY COMBO DAY 9.00AM-3.00PMI don't want this session.

TUESDAY TEEN COMBO DAY 10.00AM-4.00PM (Public Holiday Rates Apply)I don't want this session.

YESNO

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. • Cancellations more than 48 hours before the Service – Full Refund/No Charge • Cancellations within 48 hours or NO SHOW - 0% Refund/Full Payment Required if participant's session can not be filled by another participant. • Cancellations must be made in writing via email ________ Please note: WRTS’s Accounts Receivable Team will follow up any non payments in line with NDIS Policy and non payments will be reported to the NDIA. A re-fund can be left as a credit on a client’s account for future services. Refunds or Credit can not be used for Rock Shop Products.*

Yes

NDIS GROUP PRICING GUIDELINE I understand that new 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 new Line Items will be outlined in our Group Invoices and will only slightly alter the pricing. LACs, Plan Managers and Support Coords will be expecting these changes.*

I understand

OUT-OF-POCKET ACTIVITY FEE. I understand that all COMBO Days, Teen and Community Excursions incur an out-of-pocket fee to cover excursion activities and costs that the NDIS do not cover eg. tickets, supplies. Each Excursion Out of Pocket Fee will now vary. The Out of Pocket fee for each day is indicated with a colour code on the program's flyer. This will be invoiced for separately and must be paid personally, not through funding, in a timely manner. The Out of Pocket Fee adheres to the same cancellation policy as above.*

Yes, I understand and accept

2025 PRICING

See Below the updated 2025/2026 WRTS NDIS Pricing Arrangements

I acknowledge and accept WRTS Preston's 2025 / 2026 pricing.

COMPANION CARD Children Going on Excursions will require a Companion Card or the cost of the Carers' entry fee (were applicable) will need to be added to the Participant's Out of Pocket Fee. If your child has a Companion Card, please send a photo of it to WRTS Preston by email or text to 0438369077 for us to keep on file. To apply for a Companion Card visit: https://www.companioncard.vic.gov.au/

Yes, my child has a Companion CardWe have applied for a Companion Card and will send it as soon as it is received

DIETARY REQUIREMENTS & ALLERGIES Some activities have a food element to them. Does your child have any allergies/intolerances? If so, please provide details.

MEDICATION My child(ren) will require Medication to be administered by WRTS Preston during School Holiday Sessions:

Additional notes:

BOOKING CONDITIONS

I understand that by submitting this EOI Form, I am confirming my interest for We Rock the Spectrum - Preston's Weekend Group 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. It will be my responsibility to note the dates and I will receive a reminder email 48 ours before te service.

After my participant receives the services, I will be charged for each session.I will also be charged if the booking is cancelled less than 48 hours before the session's start time or if the participant is a No Show.

I understand that this EOI form will serve as a Service Agreement for the WRTS Preston Weekend Group Program, 2025.

By Signing this I agree to all Booking Conditions stated above:*

WRTS PRESTON CUP WEEKEND GROUPS - 2025

Please select your preferred Gym-Only Session Times

Please select your preferred COMBO Days