2027 Camp Kiah NDIS Service Agreement

NDIS Service Agreement

This Service Agreement is made between

Provider
ABN	Contact
15 615 893 091	PO Box 363, Wallan Vic 3756
Phone	Email
0490 252 518	maree@campkiah.com.au
and

YPID
Young Person Name

First NameLast Name
Date of Birth

DayMonthYear
NDIS Plan Number
Phone Number
Please enter a valid phone number.Format: 00 0000 0000.
Representative Name

First NameLast Name

- What Program is your participant attending?
- Start Date
  
  DayMonthYear
  Date
- End Date
  
  DayMonthYear
  Date
- Support Ratio
  Child:Adult
- Amount
  This value will fill automatically if a valid ratio is chosen
- NDIS Line Items – Core
- NDIS Line Items – Capacity
- Program
- Camp
- Theme
- Days
- Camp Name
- LookupKey 1
- Cost
- Cost
- Would you like to add a second program?
- What is your participants second program?
- Start Date 2
  
  DayMonthYear
  Date
- End Date 2
  
  DayMonthYear
  Date
- Support Ratio 2
  Child:Adult
- Amount 2
  This value will fill automatically if a valid ratio is chosen
- NDIS Line Items – Core - 2
- NDIS Line Items – Capacity - 2
- Program 2
- Camp 2
- Theme 2
- Days 2
- Camp Name 2
- LookupKey 2
- Cost 2
- Cost 2
- Would you like to add a third program?
- What is your participants third program?
- Start Date 3
  
  DayMonthYear
  Date
- End Date 3
  
  DayMonthYear
  Date
- Support Ratio 3
  Child:Adult
- Amount 3
  This value will fill automatically if a valid ratio is chosen
- NDIS Line Items – Core - 3
- NDIS Line Items – Capacity - 3
- Program 3
- Camp 3
- Theme 3
- Days 3
- Camp Name 3
- LookupKey 3
- Cost 3
- Cost 3
- Would you like to add a fourth program?
- What is your participants fourth program?
- Start Date 4
  
  DayMonthYear
  Date
- End Date 4
  
  DayMonthYear
  Date
- Support Ratio 4
  Child:Adult
- Amount 4
  This value will fill automatically if a valid ratio is chosen
- NDIS Line Items – Core - 4
- NDIS Line Items – Capacity - 4
- Program 4
- Camp 4
- Theme 4
- Days 4
- Camp Name 4
- LookupKey 4
- Cost 4
- Cost 4
- Would you like to add a fifth program?
- What is your participants fifth program?
- Start Date 5
  
  DayMonthYear
  Date
- End Date 5
  
  DayMonthYear
  Date
- Support Ratio 5
  Child:Adult
- Amount 5
  This value will fill automatically if a valid ratio is chosen
- NDIS Line Items – Core - 5
- NDIS Line Items – Capacity - 5
- Program 5
- Camp 5
- Theme 5
- Days 5
- Camp Name 5
- LookupKey 5
- Cost 5
- Cost 5

Ending this Service Agreement

Service agreements begin from the date of program attending and end the day after the program completes.

Should either you or Camp Kiah wish to end this Service Agreement, one month’s notice must be given in writing. If there is a serious breach of this Service Agreement by either you or Camp Kiah, the requirement of the notice will be waived.

Responsibilities of Camp Kiah

Camp Kiah agrees to:

Communicate openly and honestly and in a timely manner
Treat the Participant and/or the Participant’s representative with courtesy and respect
Consult the Participant and/or the Participant’s representative on decisions about how supports are provided
Give the Participants and/or the Participant’s representative the required notice if Camp Kiah needs to end the Service Agreement
Protect the Participant’s privacy and confidential information
Provide the Participant with details of any relevant changes to the availability or ability to provide the proposed support

Pricing, Payment & Invoices

Prices charged under this Service Agreement are as advised by Camp Kiah and as listed in the Services and Fees guide provided by Camp Kiah.

Camp Kiah will seek payment for the provision of services after the service has been delivered.

Camp Kiah will send you or your representative an invoice for the service we have provided to you. Our preferred method of payment is via EFT and our bank details are provided on the Camp Kiah invoice.

Camp Kiah reserves the right to suspend services until payment is received should or terms of payment be exceeded. Our terms of payment are 14 days from the date of invoice.

By signing this agreement, you agree to be personally responsible for payment of any outstanding amounts payable to Camp Kiah should you have exhausted your NDIS funds.

Cancellation of Booked Services

If you need to cancel a booking, you should do so in line with the Camp Kiah Cancellation Policy, which has been provided as a part of the NDIS Orientation Pack.

In the event of an Emergency or Disaster the young person attending Camp Kiah will be supervised and supported as per our Emergency Management plan which can be found via this link - Emergency Management Plan.

Throughout all disasters and emergencies, Camp Kiah staff will be available for communication updates via 0490252518.

Participants Representative
Date

DayMonthYear
Signature
Total Amount
Should be Empty: