Participant’s DetailsName*Participant’s Contact No*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country WHAT IS A SERVICE AGREEMENT? Service Agreement is a document. It is for you and your service provider. The service provider is the person or organisation that provides you with supports. The document says that you both agree about the services you are going to receive. When you have agreed, you both sign the document. The Service Agreement is a good way to make sure you receive the services that are right for you. And having a Service Agreement is a helpful way to make sure you have everything in writing if any problems occur. What should the Service Agreement include? The Service Agreement should include information about the supports you receive. Talk to us about your supports. Tell us: What type of supports you need, How you want the supports, Who you want to work with you, When you need supports, How long you will need the supports What is expected of you -This is about your responsibilities. What is expected of your service provider. How you can end or change the Agreement. What you can do if any problems occur. Costs How much the service costs When you pay How to pay Provider will talk to let you know: your rights what supports will be provided your responsibilities their responsibilities their responsibilities Of any considerations (if required) Together we will: Consult and talk to each other Write the agreement When do you sign the agreement? After you or your trusted has person has read the agreement. After you or your trusted person is happy that the agreement meets your need and that you have had your say. After provider agrees with what is written. Sign the agreement if you are happy to agree to what is written. Once you have signed, provider will sign. You will be given a copy of the Service Agreement. Don't forget to keep a copy of your Service Agreement in a safe place.