Balaa Supervised Transport Referral

Transport Referrer Details

Child or Young Person’s Identifying Information

DD slash MM slash YYYY
Child Restraint Required?

Parent Caregiver Details

Legal Status

Legal Status
Are there any known risks?
Has a risk assessment been completed? (Attach copy)

Details of Referral

DD slash MM slash YYYY
Total estimate travel per event from 70 Carrington Street, Lismore to pick up point and drop off point to office for return trip
Total estimate travel in kilometres per event from 70 Carrington Street, Lismore and return
Will Return transport be required?
e.g. – carer will pack food for child, entry fee to venue to be paid for by Balaa and will be reimbursed through invoicing after service delivery
Max. file size: 128 MB.
Max. file size: 128 MB.


a. In the event that the referrer cancels, recalls or suspends a Request for Services Form after 2:00pm the day before, the referrer will pay the Service Provider a sum equivalent to 3 hours of the staff rate for the applicable Service Type. No fee in respect of transport costs will be payable.
b. A minimum engagement period per mentoring event of 3 hours, including 1 hour report writing time applies for each mentoring referral.
c. Any fees or cost associated with of lateness on the part of a client, carers or parents, or other Service Provider, will be payable by the referring service.
d. Report will be available to the referrer within 48 hours of the event where requested.
e. All accounts are payable within 14 days of invoicing, multiple events will be invoiced monthly.
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