Relationship to Participant. Allow access to: ☐ NAPPA – NDSP Online Portal ☐ Monthly statements Copy of guardianship document provided? ☐ YES ☐ NO Additional Contact Person details: (if relevant) Contact Name: Contact Number (Home) Mobile: Contact Number (Mobile)
Relationship to Participant. Allow access to: ☐ NAPPA – NDSP Online Portal ☐ Monthly statements Consent to share Information: ☐ YES ☐ NO Additional Contact Person details: (if relevant) Contact Name: Contact Number (Home) Mobile: Contact Number (Mobile)
Relationship to Participant. Allow access to: ☐ NAPPA – NDSP Online Portal ☐ Monthly statements Consent to share Information: ☐ YES ☐ NO A copy of the Participant’s current NDIS plan has been provided: ☐ Yes ☐ No At any stage you may add to the above contacts by completing a Consent to Share form and providing to NDSP via email to xxxx@xxxx.xxx.xx NDIS AUDIT NDIS registered providers are required to be audited against the NDIS Practice Standards as part of the NDIS Quality and Safeguarding Framework. Clients of NDSP are automatically enrolled in the audit processes and may be contacted by the (NDSP) audit team for interviews and/or have their files reviewed to ensure NDSP is compliant. If you do not wish to participate in the audit you can opt out of the process by ticking the box below. ☐ I do not wish to be part of the audit process.
Relationship to Participant. Contingent Beneficiary(ies) & relationship to partcipant: CATCH-UP ELECTION (Select one only) Three Years Prior to Normal Retirement Age For purposes of using the catch up provision available for participants for the three years prior to the year of attainment of normal retirement age, I hereby elect a normal retirement age of and elect to use catch up for the calendar year periods beginning January and ending December understand that this catch-up election may be made only one time and that this catch-up is only available to the extent of any underutilized prior year deferrals. Attainment of Age 50 I have attained or will attain age 50 this year. I elect to use the catch-up provision available for participants age 50 and older. REQUIRED SIGNATURES I have read and acknowledge the above provisions and those contained in this Agreement. I understand that my elections above will remain effective until later changed or revoked. Distributions are allowed only upon my retirement, severance from employment, death, or incurring an unforeseeable emergency. Participant Signature Date (Continued on reverse side) I understand and acknowledge: • My agreement to defer compensation under the Deferred Compensation Plan will not be effective earlier than the first pay period of the month following the Employer's receipt of this completed Application. It shall continue in effect until modified or terminated in accordance with the provisions of the Deferred Compensation Plan. I understand that the provisions of the Deferred Compensation Plan govern the terms of my participation in the Plan and that this Participation Agreement constitutes my agreement to participate in the Plan on such terms. • Annual contributions are limited to the lesser of the dollar amount set forth below or 100% of includible compensation (generally 50% of gross compensation). As shown below, catch-up elections may be available that would allow annual contributions for the three calendar years prior to the year I attain Normal Retirement Age or for any calendar year where I am at least age 50. Catch-up is available based on the provisions contained in the Plan. Only one catch-up election may be in force at one time. Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Annual Contribution Dollar Limits 13,000 14,000 15,000 15,500 15,500 16,500 16,500 16,500 17,000 17,500 17,500 18,000 Annual Contribution Dollar Limits for the Three Tax Years Prior to Year of Normal Retirement Age Attainment ...
Relationship to Participant. 20. Phone(s):
Relationship to Participant. Day Time Phone Number Alternate Phone Number
Relationship to Participant. Phone(s): We assume this is a text-able number, but please make a note if not. Second Additional Emergency Contact Name: Who should we contact next if there's an emergency during camp? Relationship to Participant: Phone(s): We assume this is a text-able number, but please make a note if not.
Relationship to Participant. Signature of Minor Participant (if applicable) Print Name (Minor Participant) Date of Birth (Minor Participant)
Relationship to Participant. Phone Number of Emergency Contact: ( ) For the purposes of this Participation Agreement (this “Agreement”), the athlete intending to participate (collectively with his or her parent or guardian, if the athlete is a minor) shall be referred to as “Participant.” USA Gymnastics, and its officers, directors, employees, agents, volunteers, and contractors are referred to as “USAG.” The camp or event in which Participant will participate shall is called the “Activity.”
