Guest Signature Sample Clauses

Guest Signature. Date: I, agree to Kangaroo Valley Getaways processing a security bond against the credit card provided below. The security bond amount is a minimum of $300 but can be up to $2400 for the larger properties. I authorise any charges to be charged to this provided credit card in the event of any loss or expense arising from a breach of my agreement to rent the property, damage to the property or my occupation of the property. Please refer to our terms and conditions for full details. Credit Card Details for Security Bond MasterCard Visa Card Number: / / / Expiry: / Name on card: Signature: Please print this page, complete and forward it to:
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Guest Signature. Date: I, agree to a pre-authorisation of my credit to be held by Kangaroo Valley Getaways as a security bond and I authorise any charges to be charged to this provided credit card in the event of any loss or expense arising from a breach of my agreement to rent the property, damage to the property or my occupation of the property. (The pre-authorisation amount is a minimum of $300 but can be up to $2400 for the larger properties. Please refer to our website for your specific property or contact us for details). ** Please note: The security bond is processed as a pre authorisation against your card details and lasts a minimum of 5 working but can be up to 30 days depending on your banking institution. Credit Card Details for Security Bond MasterCard Visa Card Number: / / / Expiry: / Name on card: Signature: Please print this page, complete and forward it to:
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Guest Signature. Date: The guest signing this contract agrees to be responsible for the reservation and all remaining guests that occupy the rented premises including but not limited to any invited guests.
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Guest Signature. Waterloo Executive Suites shall return the security deposit ($500), less any cost of repairs as authorized by this agreement at an address the guest provides or through pre-authorized payments. Payment Details Mastercard Visa Card Number: Expiry: /
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Guest Signature. Date;............................................................................................. Witness/Duty Manager;........................................................................................
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Guest Signature. Date: My son/daughter has my permission to participate in the function listed above. I understand that I am ultimately responsible for his/her actions and behaviors. I permit Xxxxxx High School and Xxxxxx High School staff and administration to take any actions necessary to maintain orderly conduct at this function. Parent/Guardian Signature: Date: ******************************************************************************************************************************* PRINCIPAL AFFIRMATION STATEMENT AND SCHOOL SEAL FOR GUEST STUDENT By affixing my signature and school seal/stamp, I hereby attest that the student applying for out-of-school guest approval has maintained acceptable standards of behavior, attendance, and academic performance. Guest Principal’s signature: _ Date: School seal/stamp:
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Guest Signature. As a parent/guardian, I understand my obligations to pick-up my child promptly at the conclusion of the dance, or if my child is removed from the dance for any reason. In addition, I support the expectations outlined herein. Parent Name (PRINT): Parent Signature: **PHONE NUMBER: **Please provide a phone number where the parent can be reached on the night of the event. TICKET # Warhill High School School Dance Procedures and Contract for Guests of W-JCC Students Date Request Form A student requesting to bring a date to Homecoming who is not a WHS student must have this form completed and turned in to the Principal’s Office in order to attend the dance. This form requires the signature of an administrator of the guest’s school. The minimum grade level for all guests is ninth grade; the maximum age of a guest is twenty. As a WHS student, I understand that all WHS rules apply at school functions. I will take full responsibility to inform and ensure my date’s compliance to these rules. This includes. This includes compliance with the WHS dress code. I understand that if either my guest or I do not follow WHS guidelines for behavior and dress, we both may be denied entry or to remain at the dance. The final decision will be decided by the administrators present. Signature of WHS Student Grade Date As a parent of the above WHS student, I find his/her date to be a responsible person, and I approve him/her as an acceptable date for my son/daughter. Parent Signature of WHS Student Date Guest Information (Please Print) Name: Age: Address: Home Phone: School: (If not a student, please list employer and phone number.) Employer: Phone: As an administrator of the school this student attends, I verify he/she is in good standing. Signature of Administrator Title Phone Number
Sample 1
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Related to Guest Signature

  • Student Signature By signing this contract, Resident agrees to pay the contract amount (room, board and association fees) in accordance with Addendum B: Rate and Payment Schedule. Resident may pay the full amount due prior to the due date, at the Resident’s election.

  • Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.

  • AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Person(s) responsible: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Person(s) responsible’s Name Person(s) responsible Relationship to Participant Person(s) responsible’s Email Person(s) responsible’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment from us. To ensure that you do not get a text from the NDIA to approve each claim weekly, endorse Fighting Chance as a ‘My Provider’ for automatic payment processing. Instructions can be found at xxxxxxxxxxxxx.xxx.xx/xxxx/ or you can contact the Fighting Chance My Provider Endorsement Helpdesk on (00) 0000 0000 or xxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx.xx ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services once a week. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.

  • Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................

  • Signature Signature For the participant For the institution Xxxxxx Xxxxx prof. Ing. arch. Xxxxxx Xxxxxxx, PhD. Vice-xxxxxx for International Relations and Public Relations, based on the procuration Annex I

  • Legal Signature This Agreement may be executed and delivered by any party herein by sending a facsimile of the signature or by a legally recognized digital or electronic signature. Such legal signature shall be binding on the party so executing it upon receipt of signature by the other party.

  • Preparer’s Signature The person completing the DBE commitment form on behalf of the consultant’s firm must sign their name.

  • EMPLOYEE SIGNATURES Signature: Phone # / Personal E-mail: Signature: Phone # / Personal E-mail: Signature: Phone # / Personal E-mail:

  • Employee Signature Employee ID: Telephone No: Employee Address: Work Location:

  • Required Signatures a. Curriculum Academic Xxxx(s) b. Curriculum Chair(s)

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