SPIN’s Club Registration Form Name of Contact Person (Parent/Carer/Guardian) * First Name Last Name Email Phone number * Mobile or Home Participant Name * First Name Last Name Participant's age (DOB) * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Does the participant have NDIS Core funding that you can use? Yes No is the participant Self or Plan Managed? Self Plan NDIS Number Email for invoice * Can you describe the participants interests/hobbies/activities they enjoy? Give details * What is your/your young persons diagnosis/es? * Note: this is for office use only Is there anything else you would like to add about the participant attending? Confirming payment terms This check box below indicates that you are aware you are enrolling either yourself or a person you care for in the ND SPIN's Club. By ticking the box you agree to the fee of $15 per session, which will be invoiced after each session attended, by email to the address provided above. There is a 24hr cancellation policy and any non-attendance that is not notified more than 24hrs prior to the meeting start time may be invoiced for the full amount. For NDIS participants: While invoices are NDIS compliant and can be claimed against plan budgets, you acknowledge that as the guardian of the participant (or participant yourself), you are aware that you take responsibility for payment in the event of NDIS fund shortfalls or other non-payment. The Mandurah ND Centre recommends that you check the participants goals align with the goals of the ND SPIN's Club (Social participation, accessing the community, peer mentoring, and capacity building). Checkbox * Thank you for registering for the SPIN’s Club! Bring your curiosity, your enthusiasm, and your SPIN! We’re excited already. Nat x
