NDIA Managed Details My child will be attending Rainbow Club. I am unable to submit my NDIA details online. Please submit on my behalf. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastNDIS Number *Club Location *NDIS Plan Start Date *NDIS Plan End Date *Funding Support Category to Use *Core Support - Social and Community ParticipationCore Support - Group and Centre Based ActivitiesCapacity Building - Social and Community ParticipationThe 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 feesI authorise Rainbow Club to make a service booking on the NDIS portal for fees relating to monthly sessions *I authorise Rainbow Club to make a service booking on the NDIS portal for fees relating to monthly sessionsIf 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 *If there are no NDIA Managed funds available for Rainbow Club to use, I agree to pay the fees directly to Rainbow Club by credit cardParent/Carer Name *FirstLastSignature * Clear Signature Date use, fees Date *Submit See our Locations
