NDIS registration for on-demand program

Registration Form

& NDIS Service Agreement

Raising PDA Kids On-Demand Parent Education Program

Pathological Demand Avodiance for Parents: Empowering you to help your PDAer thrive.

1. Parties

This Service Agreement is for:

Client's First Name (Child) *

Client's Surname Name *

Client's NDIS Number *

Client's Date of Birth *

a participant in the National Disability Insurance Scheme (client), and is made between:

Client's Representative Name (Caregiver) *

Provider: Raising PDA Kids

ABN: 47584318501

Today's Date *

Start date of current NDIS plan *

Review date of current NDIS plan *

2. Schedule of supports

Raising PDA Kids agrees to provide the client Occupational Therapy services . The supports and their prices are set out in the attached Schedule of Supports. All prices are GST inclusive (if applicable) and include the cost of providing the supports.

3. Payments

Raising PDA Kids will seek payment for their provision of supports after the supports have been delivered.

SELF MANAGED - The client / client representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Raising PDA Kids will send the client / client representative an invoice for those supports for the client / client representative to pay. The client / client representative will pay the invoice by direct debit within 7 days. PLAN MANAGED - The client has nominated the Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Raising PDA Kids will claim payment for those supports from

Plan Manager Provider Name

Plan Manager Email Address

4. Feedback, complaints and disputes

If the client wishes to give Raising PDA Kids feedback or is not happy with the provision of supports and wishes to make a complaint, the participant can email Kate Kleinau kate@raisingpda.com

If the client is not satisfied or does not want to talk to this person, at any time, they can make a complaint to the NDIS Commission. Complaints to the NDIS Commission can be lodged:

online at www.ndiscommission.gov.au; or
by phone on: 1800 035 544.

5. Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:

a supply of supports under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the NDIS Act, in the client's NDIS Plan currently in effect under section 37 of the NDIS Act;
the client's NDIS Plan is expected to remain in effect during the period the supports are provided; and
the client / client representative will immediately notify the provider if the client's NDIS Plan is replaced by a new plan or the client stops being a participant in the NDIS.

6. Contact details

The Client Representative can be contacted on:

Client Representative Name *

Address *

Phone *

Email Address of Client Representative *

Raising PDA Kids can be contacted on:

Kate Kleinau

kate@raisingpda.com

7. Schedule of supports

I/we agree to pay for treatment/ therapy sessions provided by Raising PDA Kids t hrough claiming against the National Disability Insurance Scheme (NDIS) service plan.

Raising PDA Kids agrees to provide the client with the following Occupational Therapy supports:

Access instructions to the Raising PDA Kids, PDA for Parents online portal, along with your invoice will be emailed to you once the completed and signed service agreement has been processed. Typically this is completed within 3 business days.

Your agreement includes access to:

9 x video parent education and training modules total of 3.5 hours
Written education materials.
Learning prompts to apply strategies to your unique circumstances.
Supporting resources and guides.

Support category

Item number

Number of units

Price per unit

Total

CB Daily Activity, Improved Daily Living Skills.

Training for carers/parents

15_038_0117_1_3

3.5 hours

$71.43

$250

How did you hear about this course? *

12 . Agreement signatures

The parties understand and agree to the terms and conditions of this Service Agreement.

Signature of Client Representative *

Draw signature|Type signatureClear

Name of Client Representative *

Signed Date *

What happens next?

You will receive an email from Raising PDA Kids in the next 3 business days to confirm your registration details have been received and provide details for how to gain access to the on-demand course. If you haven't heard from me by email please double check your junk/spam.

By submitting your information, you're giving Raising PDA Kids permission to email you. You may unsubscribe at any time.

Save and Complete Later