Active Inclusive Employment Service Agreement

Active Inclusive Employment Service Agreement

1. Parties

This Service Agreement is for:

Participant First Name *

Participant Surname *

Participant Date Of Birth *

NDIS Number *

a participant in the National Disability Insurance Scheme (participant), and is made between:

Participant Representative Name *

Relationship to Participant *

Date *

2. Active Inclusive Kiosk and this Service Agreement

This Service Agreement is made for the purpose of providing Disabiliy Employment for Capacity Building or Core Funding under the participants NDIS plan.

The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:

support the independence and social and economic client of people with disability; and
enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.

3. Schedule of supports

Active Inclusive agrees for the Participant to attend our Disability employment/ SLES program . The program prices are set out in the attached Schedule . All prices are GST inclusive (if applicable) and include the cost of being supported. Additional expenses (i.e. things that are not included as part of a participant NDIS supports) are the responsibility of the participant / participants representative and are not included in the cost of the Program.

4. Active Inclusive Responsibilities

Active Inclusive agrees to:

review the provision of the Employment Program at least annually with the participant / participant representative;
communicate openly and honestly in a timely manner;
treat the participant with courtesy and respect;
consult the participant on decisions about how they participate in the Program;
give the participant information about managing any complaints or disagreements and details of Active Inclusive cancellation policy;
listen to the participants feedback and resolve problems quickly;
give the participant the required notice if Active Inclusive needs to end this Service Agreement (see "Ending this Service Agreement" below for more information);
protect the Participants privacy and confidential information;
provide an Employment Program in a manner consistent with all relevant laws, including the NDIS Act 2013 and Rules, and the Australian Consumer Law;
keep accurate records of attendance and activities provided to the participant; and
will issue invoices and statements of the Employment Program delivered to the participant as per the NDIA Terms of Business for Registered Providers as requested

5. Responsibilities of the participant / participant representative

The Participant / participant representative agrees to:

treat the Active Inclusive team with courtesy and respect;
talk to Active Inclusive management if the participant has any concerns about the Program being provided;
give Active Inclusive the required notice if the participant cannot make a scheduled day (48 hours), noting that if the notice is not provided , Active Inclusive cancellation policy will apply;
give Active Inclusive the required notice if the participant needs to end this Service Agreement (see 'Ending this Service Agreement' below for more information);
provide NDIS plan to Active Inclusive; and
let Active Inclusive know immediately if the participant NDIS plan is suspended, replaced by a new NDIS plan, or the participant stops being a participant in the NDIS.

6. Payments

Active Inclusive will seek payment for their provision of the Program after the Program have been delivered.

SELF MANAGED - The participant / participant representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. After attendance of the Program, Active Inclusive will send the participant / participant representative an invoice for the Days Attended for the participant / participant representative to pay. The participant / participant representative will pay the invoice by direct debit / EFT within 7 days. NDIA MANAGED - The participant has nominated the NDIA to manage the funding for activities provided under this Service Agreement. After providing the Day Program activities, Active Inclusive will claim payment for the program from the NDIA. PLAN MANAGED - The participant has nominated the Plan Management Provider to manage the funding for NDIS activities provided under this Service Agreement. After providing the Day Program activities, Active Inclusive will claim payment for the Day Program attended from the Plan Management Provider nominated.

Plan Manager Name

Plan Manager Agency

Plan Manager Phone Number

Plan Manager Email Address

Plan Start Date

Plan End Date

7. Changes to this Service Agreement

If changes to the Program or the delivery are required, the parties agree to discuss and review this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed and dated by the parties.

8 Ending this Service Agreement

Should either party wish to end this Service Agreement they must give 14 days notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived.

9. Feedback, complaints and disputes

If the client wishes to give Active Inclusive feedback or is not happy with the services provided and wishes to make a complaint, the client can email contactus@activeinclusive.au or complete the online inquiry form via our website.

If the participant is not satisfied or does not want to talk to this person, at any time, they can make a complaint to the NDIS Commission. Complaints to the NDIS Commission can be lodged:

online at www.ndiscommission.gov.au; or
by phone on: 1800 035 544.

10. Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:

a supply of the Day Program under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the NDIS Act, in the client's NDIS Plan currently in effect under section 37 of the NDIS Act;
the client's NDIS Plan is expected to remain in effect during the period the program provided; and
the participant / participant representative will immediately notify the provider if the client's NDIS Plan is replaced by a new plan or the client stops being a participant in the NDIS.

11. Cancellation Policy

At Active Inclusive we value consistent and high quality support. If you need to cancel an appointment it is recommended it occur 48 hours before commencement of the Day Program to avoid a cancellation fee. If you contact Active Inclusive within 48 hours before the booked day of the Day Program there will be a cancellation fee of 100% charged to your account and payment due. Where Active Inclusive cancels a Day Program due to operational reasons, the Day Program will be rescheduled at no penalty to either party. Where multiple cancellations or no shows occur in a 12-month period, Active Inclusive will cancel any future bookings.

I have read & understood the cancellation policy *

12. Contact details

The Participant Representative can be contacted on:

Participant Representative Name *

Alternative contact person

Address *

Phone *

Email Address of Participant Representative *

13. Schedule of Programs

I/we agree to pay for Attendance at Employment Programs provided by Active Inclusive through claiming against the National Disability Insurance Scheme (NDIS) service plan.

Start Service Date *

Finish Service Date *

The Provider agrees to provide the participant attendance and participation in the Employment Program for the duration of the agreement at the scheduled rate. These include

Attendance at the Employment Programs
Cancellation charges for late notice or no show appointments

Active Inclusive reserves the right NOT to provide service or to cancel any future booked days for the participant if you do not have sufficient funds in your plan or the plan expires. Any service fees not met by NDIS will be covered by your participant/participant representative.

Where the support will be provided *

Active Inclusive Program - No 2 Sports Ground, Smith Street Newcastle West NSW 2302Active Inclusive Program - Branxton Community Hall, 35 Bowen Street, Branxton NSW 2335Active Inclusive Program - 63 Broadmeadow Road, Broadmeadow NSW 2292Active Inclusive Program - Offsite by Special Arrangement with Active Inclusive

Frequency of support *

1 x day per week (4 hours)2 x day per week (8 hours)3 x day per week (12 hours)Other (Please Specify)

Choice of line item for the plan to be charged from *

Core- 04_801_0133_5_1 Supports in EmploymentCapacity Building- 10_806_0133_5_1 Supports on the Job Capacity Building- 10_016_0102_5_3 Employment SupportCapacity Building- 10_021_0102_5_3 SLESOther

I agree for the plan to be charged for:
10_011_0128_5_3 Employment related assessments and counselling with Behaviour support and OT $193.99 hr (20 per plan)
04_599_0133_5_1 Centre Capital Cost $2.53

The total funding claimed by this service over the period of this service agreement will be

1 4. Agreement signatures

The parties understand and agree to the terms and conditions of this Service Agreement.

Due to the nature of the program and activities there is potential for injury and harm. Active Inclusive will endeavour to alleviate these risks. However I acknowledge and take responsibility for those risks and injury that may occur during activities.

Signature of Participant Representative *

Draw signature|Type signatureClear

Name of Participant Representative *

Signed Date *

Copy of NDIS plan

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