Booking Form WheelTalk Program The WheelTalk Disability Awareness Program is an initiative of Disability Sport & Recreation (DSR). The program encourages students to think about diversity, acceptance and disability sports as well as give them a greater understanding of the issues facing people with a disability. The sessions run for up to 1.5 hours each, comprising a presentation by a DSR ambassador, and a practical component of playing wheelchair sport which can accommodate up to 30 students per session.

Pricing • $300 for the first session, Monday-Friday • $100 per every session thereafter on the same day • If there is a gap greater than one hour between sessions, an extra:

o $100 is charged to cover the presenter’s costs o $300 for the first session on every subsequent day

• $100 extra for schools further than 70kms from our base in Fitzroy to cover the presenter, and additional running costs.

Please be advised that as Disability Sport & Recreation is a charity registered for GST, all goods and services provided should incur a 10% GST charge. Pricing outlined on the booking form is GST exclusive. The GST charged on WheelTalk sessions can be claimed as an input tax credit/GST credit if you are registered for GST. An invoice will be sent to you at the beginning of the month for which WheelTalk comes to your school. Payment is required within 14 days of receiving this invoice. If there are any issues, please contact: wheeltalk@dsr.org.au Cancellations • 48 hours’ notice is required to cancel or reschedule a WheelTalk

booking. Failure to provide this, the full WheelTalk fee is still expected to be paid.

• If your program is to be held outside, DSR is not liable for cancellations due to wet weather. Full payment of the program is still expected to be paid.

Booking Form

Contact Details School name:

School reception no:

Contact name:

Email address:

Venue address:

Town/City: Postcode:

Booking reminder by: Text (please provide mobile number) Email Phone call

Venue Details To assist our presenter, please provide map if possible. Please show: - School layout

- Position of court- Parking area – for car & trailer- Meeting place

Other important information (please mark) Gym is wheelchair accessible Yes / No Accessible Toilets Yes / No Wet weather / indoor facilities Yes / No Basketball court Yes / No Basketball rings Yes / No

Topics Are there any specific topic you would like us to focus on (please tick)

Benefits of a healthy lifestyle Road Safety

Risky Behaviour Workplace Safety

Other

Booking Form

Sessions Requested: If you require multiple sessions, please indicate specific times and include any breaks

DATE TIME YR. LEVEL GROUP SIZE

Photos Permission for DSR to use any images taken from for marketing and communication purposes, including social media Yes / No

Donations: All groups taking part in this program are asked, at their discretion, to make a donation to Disability Sport & Recreation.

Billing amount: _____________________

Donation amount: _____________________

Please return your completed form to: Email: wheeltalk@dsr.org.au or fax: 9473 0134

Name: ______________________________

Signature: ___________________________ Date:___/___/___ *Please note: your booking can not be confirmed until DSR has received your

completed and signed booking form.