Plan Managed NDIS Details My child will be attending Rainbow Club in the upcoming term. I am unable to submit my Plan Manager 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 *Plan Manager *Email Address for Invoices *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 Participation that end I 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 my child has the appropriate funding for Rainbow ClubI authorise Rainbow Club to invoice my child’s Plan Manager at the end of the term *I authorise Rainbow Club to invoice my child’s Plan Manager at the end of the termI understand that if my Plan Manager does not pay the fee invoice, I will be responsible for the payment in full *I understand that if my Plan Manager does not pay the fee invoice, I will be responsible for the payment in fullI authorise Rainbow Club staff to submit the Service Agreement on my behalf *I authorise Rainbow Club staff to submit the Service Agreement on my behalfParent/Carer Name *FirstLastSignature * Clear Signature Date *Submit See our Locations
