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Day Programs Enrolment Form

    Gender

    Address

    NDIS Information

    Is the paticipant plan managed?

    Emergency Contact Information

    Emergency Contact Name

    Alternate Emergency Contact Name(optional)

    Program Information

    Preffer days for Attandance

    Preferred Activities (Please tick all that apply):

    Preferred Support Ratio:

    Health and Medical Information:

    Does the participant have any medical conditions or health concerns we should be aware of?

    Consent and Acknowledgment:

    By signing this form, you consent to Majestic Living Australia using your personal andhealth information in accordance with privacy laws and to provide the necessary servicesunder the NDIS Day Program.

    Date

    Majestic Living Australia – Registration & Membership Fee Policy

    One-Time Registration & Annual Membership Fee:

    1. A $50 non-refundable registration or membership fee is required per year.

    2. This fee applies to all participants upon enrolment and must be renewed annually.

    3. Participants will not be able to start the program until payment is confirmed.

    For more details or payment assistance, please feel free to contact us.
    BANK DETAILS: BSB: 065137 ACC NO: 10856309
    NAME: MAJESTIC LIVING AUSTRALIA REF: DAYP
    (PLEASE ENSURE TO ADD YOUR NAME FOR OUR REFERENCE WHEN MAKING
    THE PAYMENT)

    Advance bookings are required to ensure proper staffing and catering arrangements. Unfortunately, we may not be able to accommodate walk-ins, and you may be asked to return at a later time. Please secure your session by booking in advance.

    Health and Medical Information:

    Date of Enrolment:

    Staff Member Processing Enrolment:

    Start Date of Program:

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