Blue Rock Lakeside Adventure

Service Agreement

Inclusions

Team Building Outdoor Recreation Activities
Kayaking, Mountain Bike Riding, Scenic Walks, Fishing, Table Tennis
Hot Lunch and Drinks

Location

Blue Rock Lake Picnic Grounds, Willow Grove

Date and Time

Friday 17 February 2023 from 10.30 am to 2.30 pm

Costs

The event can be NDIS funded.

A breakdown of the costs are:

Social Support Charges

$373.02 ($62.17 x 6 hours including lunch, activities, insurance, registration and administration time)

Individual 1:1 Weekday Daytime (04_104_0125_6_1)

Notes

Actual costs may be subject to change depending on venue/catering hire amendments that may occur by other providers required for the event which are outside of our control.

Any out-of-pocket expenses incurred by Rooster Tours Pty Ltd such as catering, activities and equipment will still be charged if the service is cancelled by the participant within 72 hours before the event.

GRAND TOTAL

$373.02* excluding provider travel, activity travel and extra person charges (if required)

*Provider Travel: $1.00 per/km pro rata per participant under 04_799_0125_6_1

*Activity Travel: $1.00 per/km pro rata per participant under 04_590_0125_6_1

*Extra Person: $87.17

I agree with the charges under my NDIS plan and the cost is to be paid in full after the event

Participant Registration Details

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

Address *

Attendance

I confirm my attendance to the 'Blue Rock Lakeside Adventure'

I would like to bring an extra person to the event

Extra Person Name and Relationship

Transport

I require transport (activity travel) to and from the event

Participant Emergency Contact Details

First Name

Last Name

Phone Number

Medical Information

GP Contact Name

GP Contact Phone

Medical Conditions

Medication Requirements

Dietary Requirements

Any Other Important Information

Social Media

By ticking this box, I give consent to Rooster Tours Pty Ltd to taking, displaying and publishing digital photographs of myself undertaking activities during sessions on their website, Facebook, Instagram and any other relevant social media platforms for marketing and promotional purposes.

Privacy Policy

By ticking this box, I consent to my private information being held, protected and shared by Rooster Tours Pty Ltd in accordance with the privacy policy. A copy of the privacy policy is available on request via info@roostertours.com.au and are publicly available via Terms & Conditions (roostertours.com.au)

*

Code of Conduct

By ticking this box, I agree and adhere to the Code of Conduct of Rooster Tours Pty Ltd. A hard copy of this document is available upon request via info@roostertours.com.au or can be viewed at Terms & Conditions (roostertours.com.au)

*

Cancellation Policy

By ticking this box, I understand that supports cancelled with less than 72 hours’ notice (excluding medical emergency, family emergency, environmental emergency or Covid related circumstances) will be charged at 100% of the program cost.

*

By ticking this box, I understand that supports cancelled with less than 2 weeks’ notice (excluding medical emergency, family emergency, environmental emergency or Covid related circumstances) will be charged a cancellation fee to cover the costs incurred by Rooster Tours Pty Ltd or Gateway Participation Pty Ltd due to the short notice.

*

Feedback, Complaints and Disputes

If the participant wishes to give the provider feedback, the participant can contact Rooster Tours Pty Ltd via the contact details below . If the participant is not satisfied or does not want to talk to this person above, they can contact the NDIS Commission by calling 1800 035 544, visiting one of their offices in person, or ndiscommission.gov.au for further information.

Contacts

Natalie O'Shea

Director, Rooster Tours Pty Ltd

0414 377 347 | info@roostertours.com.au | www.roostertours.com.au/contact

Participant Signature

Signature *

Draw signature|Type signatureClear

Date