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.

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Child's Name

First

Last

NDIS Number

Club Location

Plan Manager

I Date Signature

Email Address for Invoices

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 my child has the appropriate funding for Rainbow Club
I authorise Rainbow Club to invoice my child’s Plan Manager at the end of the term
I understand that if my Plan Manager does not pay the fee invoice, I will be responsible for the payment in full
I authorise Rainbow Club staff to submit the Service Agreement on my behalf

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