Bulleen Heights Special School January 2019 Vacation Care Program [Booking Request Only]

Parent/Guardian Information

Account Holder

Child/ren's Full Name/s

Day Date Activity Day Cost
Child 1
Child 2
Child 3
Child 4
Mon 07-Jan-2019 Sensory Mess Day 130.00
Tue 08-Jan-2019 Take Flight 130.00
Wed 09-Jan-2019 Let's Go Bowling (Excursion)
You have read the risk assessment pertaining to this excursion and accept all the information provided on the risk assessment and accept your child or children being part of this excursion day.
Thu 10-Jan-2019 Mix It All Up 130.00
Fri 11-Jan-2019 Cooking Factory 130.00
Mon 14-Jan-2019 Beartastic Fun 130.00
Tue 15-Jan-2019 All Stars Summer 130.00
Wed 16-Jan-2019 Disney Vs Pixar Day 130.00
Thu 17-Jan-2019 Edible Art 130.00
Fri 18-Jan-2019 Science Magic Day 130.00
Mon 21-Jan-2019 Crazy Circus Time 130.00
Tue 22-Jan-2019 Water Active Play Day 130.00
Wed 23-Jan-2019 Mess Mania 130.00
Thu 24-Jan-2019 Amazing Creations 130.00
Fri 25-Jan-2019 Everyone's Birthday 130.00
Estimated TOTAL (before eligible CCS adjustment):

Additional Information Required to Proceed:

How would you like to pay?

Direct Debit from my nominated bank/credit card account (only available until 14-Dec-2018 4:00pm)
Credit Card via Secure Online Form
Invoice to Approved Respite Agency (only available until 14-Dec-2018 4:00pm)
Grandparent Child Care Subsidy
Card Type:
Credit Card Number:
CVV Security Number:This is a 3 digit number usually near the signature panel.
Expiration Date:

Please ensure all Credit Card details (number/ expiration date/ CVV) are correct. As declination fee, will apply if entered incorrectly or not entered or part entered.

Name of Respite Agency:
Name of Caseworker:
Phone Number of Respite Agency:
Email address of Caseworker:
Name of NDIS Caseworker:
Phone Number of NDIS Caseworker:
Email address of NDIS Caseworker:

I have read, accept and agree to the Company Terms & Conditions.

Disclaimer: I understand and acknowledge once I have submitted the online Vacation Care Booking Request it is a confirmation of my child/renís individual booking day/s and will be processed with the days selected. I understand and accept that After The Bell Aus will use my nominated payment method for the total Vacation Care costs and any past debt amounts once the Vacation Care request booking form has been processed and until my account is at a zero balance. It is my responsibility to contact After The Bell Aus Head Office if I have not received a statement after submitting the Vacation Care Booking Request and/or if booked days do not reflect my online Vacation Care booking request. I accept any applicable dishonour/ declination fee associated with this booking request as a result of insufficient funds or incorrect banking details provided or not providing updated banking details. I understand that submitting this booking request form from a non-PC device is at my own risk.

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Head Office
1220 Burwood Highway
Postal Address
PO Box 7082
Contact Us
03 9758 6744
Email us here