Returning family invoice request

Fill out the below form and our team will send you an invoice. Note: This registration form is for exisiting and returning families who require an invoice. If you are a new family or do not require an invoice, please register through Registration Page or email info@abilitiesunlimited.com.au for more information.

Parent/carer information

Parent name

First Name

Last Name

Parent email

Parent phone

Home address

Child information

Child name

First Name

Last Name

Child gender

Child age

Child date of birth

List three term goals in attending the program this term.

Emergency contact information

Emergency contact name

First Name

Last Name

Emergency contact number

NDIS Information

NDIS funding is not required to attend programs. However, if NDIS funding will be used please provide the following details:

NDIS Number (if applicable)

Are funds self-managed or plan managed? (if applicable)

Plan manager name (if applicable)

Plan manager organisation (if applicable)

Plan manager email (if applicable)

Plan manager phone (if applicable)

Would you like invoices directly sent to your plan manager? (if applicable)

Yes

Media

I give AUA permission to take photographs and / or video for the purposes of promoting AUA programs.

I give permission

Social participation

I understand that that parent/carer attendance is mandatory at the program.

I understand

Ongoing registration

• In order to ensure your place is secure and provide continuation for your child we would recommend you consider requesting ongoing program. • In selecting this option 2 weeks prior to each term you will be invoiced for the following term. • Term cancellation is available by emailing info@abilitiesunlimited.com.au no later than 2 weeks prior to the commencement of each term.

I would like ongoing registration for my child.

Yes

I understand I will be invoiced 2 weeks prior to each term until I provide cancellation in writing.

I understand

Agreement

I agree to the terms of this agreement. I understand that AUA is a not-for-profit association designed to promote development for children with diverse abilities to develop skills and confidence to participate in active recreation and community sport.

I agree and understand

Program(s) (include program name(s), level and preferred time)

Returning family invoice request

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