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This Service Agreement is for a Participant in the National Disability Insurance Scheme (NDIS), and is made between:
NOTE: A Service Agreement can be made between a Participant and a Provider or a Participant’s representative and a Provider. A Participant’s representative is someone close to the Participant, such as a family member or a friend or someone who managers the funding for supports under a Participant’s NDIS plan.
AND: The Provider: Able2 Pty Ltd (Able2)
The NDIS and this Service Agreement
This Service Agreement is made for the purpose of providing supports under the participant’s NDIS plan. The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:
1. Support the independence and social and economic participation of people with disability, and
2. Enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.
If the date of this agreement is after the date of commencement, the parties acknowledge that this agreement ratifies and
formalises the de facto verbal agreement that was in place between the date of commencement and the date of signature.
Furthermore, the Participant and/or their Representative agrees that additional services may be requested from time to time.
If this is the case these may be added to this agreement as long as this is done in writing. Electronic messages received from
the Participants mobile phone number or email address will be considered such agreement in writing. The participant/
participants representative agree that Able2 may claim more than 30 minutes travel.
This agreement includes the attached Schedule of Supports, Provider List, Consent Form, Terms & Conditions and additional information for Plan Management if applicable.
Able2 will seek payment for their provision of supports after satisfactory delivery of support by sending an invoice or in the case of the NDIA, claiming direct. In all cases the Participant or the Carer are ultimately responsible for payment for services rendered if funds are not available from the NDIS. In the case of groups that run for more than one session, payment is due in full for all sessions after the first session has met. Payment should be made no later than 7 days after the date of the invoice. Select from the list below - one or more may apply:
The parties agree to the terms and conditions of this Service Agreement.
Able2 Client Data & Privacy Consent
I understand my rights and responsibilities as outlined in My Service Agreement and I confirm that they have been explained to me. I understand my personal information is protected, and that no information about me will be released without my prior agreement. I have been given enough information to enable me to make an informed choice before granting my consent. I understand I have the right to withdraw my consent at any time. This consent may be varied by electronic communication means. Such communications, if they have been sent from your telephone number or social media or email address will be included in this consent.
Collection of Information
I give my consent for Able2 to collect my information as follows:
1. Personal information collected will depend on my relationship with Able2 and the service I have requested. It may include:
a. my name, addresses, email address, phone number, date of birth, gender, identification details
b. payment information in connection with a service or donation
c. needs and circumstances (such as living or financial circumstances)
d. information requested by Able2 from other health professionals and other community supports or service agencies involved in my care in order to implement my NDIS plan, strengthen my capacity or address barriers to participation.
e. information requested by the NDIA.
f. Internet Provider (IP) address or domain when using our website
g. if you use social media to interact with Able2, any information that you allow the social media site to share with Able2
h. my working and/or donation history
2. Sensitive information will only be collected if it is specifically required for operational reasons. It may include my racial or ethnic origin, political opinions, religious or philosophical beliefs or affiliations, details of health, disability or criminal record; and/or my sexual orientation
3. I acknowledge there are some exceptions that do not require my consent. These include:
a. Able2 must/needs to collect my information by law
b. when the information is necessary for a legal claim
c. my membership of a professional or trade association
d. my membership of a trade union
Sharing of Information
In all cases information will only be shared with specific people or organisations that I have nominated, either in the attached appendix or provider list, or that is given by me to Able2 by electronic means as part of this consent. I give my consent for Able2 to:
1. Discuss my NDIS plan implementation with other health professionals currently involved in my
care, including requesting information from health professionals about my care.
2. Release my personal information to other health professionals or service agencies to which I have agreed to be referred to in order to implement my NDIS plan.
3. Release de-identified information about the type and frequency of services provided to me for the purpose of data collection, analysis and reporting.
4. Release my information to other service agencies in the event of natural disaster or emergency where I may be directly impacted for the purpose of my safety.
5. Release my information to other agencies as needed for any audit and/or compliance checks.
Name of person or organisation
Able2 may release my information to this person/provider
Throughout the year there will be some memorable moments on our programs and groups. We would love to be able to capture these moments and share them with our community. We will only share your image/your young person’s image with your consent.
I hereby give my unconditional permission to Able2 to use my photographic/filmed image for the purposes of promoting, publicising and advertising Able2. I understand the image(s) will remain the property of Able2 and may be used in its publications, website, and other publicity material and I expressly authorise such use. I give express permission for Able2 to crop or alter the image(s) as necessary.
I waive any right to royalties or other compensation arising from or related to the use of the image. If you wish to allow us to use these photos or videos, please sign in the space below.
Schedule of Support Prices
1. I agree to accept one or more of the services listed below according to the goals & budgets set out in my NDIS Plan.
2. I accept the prices stated below or as per the current NDIS schedule of supports as published by the NDIS from time to time.
3. Where a participant joins an activity for a term the total for the whole term is payable irrespective of attendance after the first session.
(02) 4760 firstname.lastname@example.org