NDIA Managed Details

My child will be attending Rainbow Club in the upcoming term. I am unable to submit my NDIA details online. Please submit on my behalf.

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Child's Name

First

Last

Child's that I

NDIS Number

Club Location

NDIS Plan Start Date

NDIS Plan End Date

Funding Support Category to Use

The NDIS Quality and Safeguards commission has approved Rainbow Club’s registration as a registered NDIS provider under section 73E of the National Disability Insurance Scheme Act 2013 (NDIS Act). The most recent certificate of registration is dated 08 November 2024 and covers Social and Community Participation and Group and centre-based activities.

I acknowledge that

I confirm that funds are available in this plan for Rainbow Club fees
I authorise Rainbow Club to make a service booking on the NDIS portal for fees relating to the term dates
I understand that Rainbow Club will make 2 claims with NDIA: the first claim for 50% of fees will be made in Week 3 and the second claim for 50% of fees will be made in Week 7 of each term
If there are no NDIA Managed funds available for Rainbow Club to use, I agree to pay the term fees directly to Rainbow Club by credit card

Parent/Carer Name

First

Last

Signature

Clear Signature

Date

Locations

Acacia Ridge (QLD), Altona (VIC), Armidale, Auburn, Batemans Bay, Baulkham Hills, Bexley, Blayney, Bondi, Bruce (ACT), Burwood, Callaghan/Kotara, Calwell (ACT), Caringbah (Active Moves), Castle Hill, Charlestown/Newcastle City, Cherrybrook, Coffs Harbour, Currimundi, Denistone East, Dubbo, Erina, Everton Hills(QLD), Fairy Meadow, Five Dock, Freshwater, Glenmore Park, Gregory Hills, Gunnedah, Hoppers Crossing (VIC), Hurstville, Kensington, Kilsyth (VIC), Kurri Kurri, Lane Cove, Lane Cove West, Laverton, Lithgow, Liverpool CBD, Liverpool, Loganholme (QLD), Maitland, Maroubra, Mt Annan, Mt Ommaney (QLD), Mt Pritchard, Muswellbrook, Narellan, Newington/Stanmore, North Sydney, Norwest, Orange, Penrith, Queanbeyan, Revesby, Sans Souci, Seven Hills, Seven Hills North, Southern Highlands, Southport (QLD), Springwood, Strathfield, Sutherland, Sylvania, Tamworth, Taree, The Ponds, Tuggerah, Wahroonga, Warriewood, Warringah, Warwick Farm, West Pymble, Windsor, Wollongong, Woolooware. See details