School Holiday Day Program

Booking Form

NDIS Participants aged 13–17

📍 Program Location: The Hub, Nerang

🕘 9:00am – 3:00pm | Monday 22 September – Friday 3 October 2025

👫 Support Ratio: 1:2

👤 Participant Details

First name

Last name

Birthday

Day

Month

Year

NDIS Number

Primary Diagnosis

Parent/Guardian Name

Parent/Guardian Number

Funding Management

Plan Managed

Self Managed

Email address for invoicing

Support Coordinator (if applicable)

Support Ratio

1:2 (Group)

1:1 (if required)

🚌 Transport Options

I will arrange my own transport to and from the Hub in Nerang

I require drop-off and/or pick-up (additional charge applies, a quote will be provided)

If you require transport to and from the Program, please provide the address so a quote can be provided:

🕘 Extra Support Hours

Please check this box if you would like extra support hours outside the 9am - 3pm program time (i.e you would like your child to stay with us until 5pm). We will be in contact to discuss the arrangements.

🥗 Lunch • Morning Tea, Lunch and Afternoon Tea are included with this group. Please provide information relating to any food allergies or aversions:

🔉 Sensory or Support Needs Please list any sensory sensitivities, regulation tools, or strategies that help:

Emergency Contact 1

Emergency Contact 2

📅 Booking Selection

I would like to book all 10 days... OR;

Please select individual days that you would like to book:

✅ Week 1

Mon 22nd September – “All About Us” Day (Hourly Rate Only)

Tues 23rd September – Outdoor Chill & Games (Hourly rate + 8km)

Wed 24th September – Game On! Challenge Day (Hourly Rate Only)

Thurs 25th September – Currumbin Wildlife Sanctuary (Out-of-pocket cost: $50) (Hourly Rate + 25km)

Fri 26th September – Hub Cinema Day (Hourly Rate Only)

✅ Week 2

Multi choice

Mon 29th September – Creative Cooking Day (Hourly Rate Only)

Tues 30th September – BBQ & Group Games (Hourly Rate + 10km)

Wed 1st October – “This Is Me” Art Day (Hourly Rate Only)

Thurs 2nd October – Bowling Day (Hourly Rate +10km)

Fri 3rd October – Pizza Party & Celebration (Hourly Rate Only)

✅ Authorisations

I consent to my child participating in the September School Holiday Program

I understand the daily support is charged at $37.70/hr from Core Supports (1:2 ratio + Centre Capital Costs)

I understand that activity-based transport will be charged to the plan as outlined above, as well as in a quote if extra transport has been requested by me.

I understand the $50 out-of-pocket fee for Currumbin Wildlife Sanctuary applies only if I select that day and that I will be invoiced separately by Loving Life Support Services

I will receive a Service Agreement for all selected supports