School Holiday Group Booking Form

Child's Name *

First

Last

Date of Birth *

Email *

Address *

Emergency Contact Name *

Emergency contact Phone Number *

NDIS Number (if NDIS Participant)

Please select all the groups you would like to attend *

Agreement: *

By clicking submit, you agree to the following: - Upon confirmation of a group session, please note that cancellations are not permissible, and the session fee is non-refundable. We appreciate your understanding in honouring the commitment once scheduled.

Private and Self-Managed NDIS Clients: *

Once your child's place in a group has been confirmed, an invoice will be sent to you. Please arrange payment within 7 days of the invoice date.

Plan-Managed NDIS Clients: *

The invoice for the groups will be sent on the day of the chosen group. Please ensure that your plan will be valid and there will be funds available. In the circumstances that there is insufficient funds, you agree to pay for the group within 7 days of being invoiced.

Please state if your child is privately funded, self-managed NDIS or plan-managed NDIS. *

If Plan-Managed, please provide the Plan Manager's invoicing email address

If you have any issues with this form or have any queries about these groups, please email admin@perthhillsalliedhealth.com.au and we will get back to you as soon as possible. Please note that our clinic is currently closed but we will be checking our emails intermittently through the festive period.