|
CONTRACT OF STAY
|
| Funded by Local
or Area Health Authority |
| NAME OF GUEST .................................................................................................................................. |
| DURATION OF STAY AT THE CRISIS
CENTRE .......................................................................... |
| PERIOD ON SUPPORT PROGRAMME .......................................................................................... |
| The concessionary rate for a Local Authority or
Area Health Authority funded guest at: |
| The Crisis Centre is: |
£...............
|
per week |
| Fee for Support Programme is: |
£...............
|
per week |
| Please Note that the fees
are subject to review on the 1st January each year. |
| We would appreciate if funding authorities could
pay invoices two weeks in advance or on the due date to enable the
Centre to keep administration costs at a minimum. |
| A) |
We, the undersigned, agree to the conditions of acceptance
of stay as set out in this statement of Financial Responsibility. |
| B) |
THE ARBOURS SUPPORT PROGRAMME; in addition,
if the guest is accepted to the programme, we, the undersigned agree
to fund the Arbours Support Programme at a rate of £90.00
per week. |
| ............................................................................................................ |
| Signed on behalf of the Funding Authority |
| Name (Block Capitals): |
| Position: |
| Social Services: |
| Address: |
| |
| ADDRESS FOR BILLING (BLOCK CAPITALS
PLEASE) |
| |
| |
|
