Chakra Care School Holiday Program EOI

At Chakra Care, we look forward to partner with you to achieve your goals.

Welcome to our school holiday program. Below are some things to note:

All participants of the school holiday activity must have 1:1 support unless otherwise agreed by the organiser
Chakra Care Participants please contact your team leader for bookings
Participants are responsible for packing own lunch or bring own lunch money
For outdoor activities: hats, sunscreen, long sleeve shirts, water bottles
Please bring companion card if the participant has one
If you are not a Chakra Care Participant, please complete this form and the Chakra Care SHP Legend will be in touch shortly.

The availability of the program is on first-come, first-serve basis. If any of the programs capture your interest, we encourage you to complete this form as soon as you are ready to secure a spot in your program. We will be in touch as soon as possible.

Name(Required)

First Last

Email(Required)

Phone

How will the applicant pay for the school holiday program participation?(Required)

NDIS Plan - plan or self-managed

NDIS Plan - NDIA managed

Other funding packages

Applicant will be paying out of pocket

NDIA Approval(Required)

Yes I have NDIA approval for Chakra Care to invoice my plan

Thank you, I will try again next school holidays.

We are soon to be registered; however, at this stage, we are only invoicing plan managed or self-managed participants. Please provide NDIA pre-approval before submitting the application.

Funder Approval(Required)

Yes I have the funder's approval for Chakra Care to invoice my plan

Thank you, I will try again next school holidays.

Non-NDIS funded applicants Whilst we can work with non-NDIS funded applicants, we will require evidence of pre-approval from your fund holder to ensure that our school holiday program activities is covered under your funding package.

Your relationship with the school holiday program applicant(Required)

Parents and/or legal guardian

Family member

Case manager / support coordinator

Plan manager

Health professional

About the school holiday program applicant

Name(Required)

First Last

Address

Street Address Address Line 2 Suburb State Post Code

Phone(Required)

Date of Birth(Required)

Gender(Required)

Female

Male

Transgender Female

Transgender Male

Gender Variant / Non-conforming

Prefer not to say

Other

Participant Disability (reason for being on NDIS) or write 'applicant does not have a NDIS plan'

Chakra Care School Holiday Program EOI

Chakra Care School Holiday Program EOI

About the school holiday program applicant

The 1:1 Support Arrangements

Support Preference

Invoicing Details

Plan management (NDIS Participants)

Invoicing details (plan manager details)

Invoicing details (fund manager's details)

Invoicing details (paying out of pocket)