Notice: Undefined variable: result in /mnt/web/html/trustedtravel.org.au/includes/template/bookings.php on line 9

Trusted Travel Group Holiday Booking Form

Are you a new or existing client to The Disability Trust? *

How did you hear about us?

Gender *

Information for Emergency Use Only

Please note that The Disability Trust requires at least one emergency contact on file for your safety.

Medical Information

Dietary Requirements *

Medication *

Do you give permission to give Paracetamol? *

Do you have a specific medical action plan/information? *

(Please attach if required)

Media

I give permission for

to appear in photos for

*Identification purposes (e.g. in client files or on medication)

Media photos on websites, advertising, etc.

Swimming Please Tick
If you are permitted to go in the water

(Please note Non swimmers will be permitted to wade in shallow water only)

If you are a swimmer, please tick what is applicable
Support Needs Group Holiday

Please check which best indicates your personal situation

Support Needs - Living Arrangements/Accommodation
Support Needs - Daily Activities/Personal Care
Support Needs - Eating and Drinking
Support Needs - Finances
Support Needs - Behaviours of Concern
Support Needs Continued & Additional Information Overnight support
Accommodation Preferences
Money Handling Assistance Required
Personal Care/Continence Assistance Required
Mobility
Possible Behaviour Triggers (if any)
Likes and Dislikes (Food, drinks, places, smells, sounds etc.)
Smoker

IT IS ESSENTIAL THAT THE INFORMATION PROVIDED TO TRUSTED TRAVEL IS CONSISE AND COMPLETE, FAILURE TO PROVIDE DETAILED INFORMATION MAY RESULT IN PARTICIPANTS EXPERIENCE BEING COMPROMISED.

Holiday Details
Frequent Flyers
Preferred Employee for Supports (if applicable)
NDIS Goals (if applicable)
Relevant NDIS payment information (if applicable) Payment method

*If you select use of your NDIS plan, please fill out the below information

NDIS Plan management method
For Plan Managed Participants
For NDIA Managed Participants

I do hereby agree that The Disability Trust will make a service booking for the amount of funds required for the holiday requested. I will be forwarded a Service Agreement and Schedule of Supports as relevant to the holiday selected.

Invoice Method *
Terms and Conditions