I-Listen · registration

Sign your little one up for I-Listen.

Fill in the form, sign it on your screen and send it to your Biolink centre. You’ll get a signed PDF copy to keep.

Your child

The little one who’ll be doing I-Listen.

Their pre-school or crèche.

Date of birth

Gender

Please say what they take. Leave it blank if there’s nothing.

Person responsible for the account

Usually a parent or guardian: the person the debit order is for.

13-digit SA ID, or your passport number.

Who to call about important things

The person we contact if something comes up during a session.

Centre & payment

56 sessions of 30 minutes, paid by monthly debit order.

Not listed? Choose “Not sure yet” and head office will help.

Sessions2 × 30 min a week for 28 weeks
Per sessionR125
Monthly debit orderR875 × 8 months
TotalR7 000

Every student gets a free FOCUS assessment after completing the sessions.

Debit order date

Read, initial & sign

Your name and centre are filled into the terms as you go.

Terms and conditions

I (Names & Surname), , with ID no hereby acknowledge that I am responsible for paying the account that I will receive for Biolink sessions as agreed. Payment will be by debit order on the of each month. Failure to pay on the account terms, I will be responsible for all costs to be incurred in the amount owing to progress; it includes all administrative and legal costs.

In the event of the relevant account not having sufficient cleared funds to meet any debit, I am aware that a fee will be debited against my account by Biolink relating to the return of the debit and I accept the responsibility to ensure sufficient, cleared, and available funds. I (Full name and surname) accept that an R75 penalty fee will be added to my normal fees in the case of a late payment or reversed Debit Order.

Furthermore, upon signing this document I indemnify Biolink , any employee of the center as well as the owner of the premises against any damage, loss, and or injuries, including any bodily physical injuries sustained on the premises during playing in the center, injuries resulting from the transport of the client on the instruction of the parent/guardian, hijacking, abduction and any motor vehicle-related injuries, the client and/or the parent/guardian of the client can receive. The client is at their own risk and it remains my duty as undersigned to ensure the safety of the client. I as parent/ guardian hereby confirm that the client is physically and emotionally able to visit the Biolink Centre and is under my / our control to send the customer to the center for the necessary treatment/sessions.

I confirm that the necessary consent of the mother/father/guardian of the client has been obtained and I also attach the written consent if it is not possible for both parents to complete and sign this document.

  1. Only payments via debit order will be accepted.
  2. This Initial payment agreement will commence on the date as indicated on the Stratcol Debit order form by (Full name and surname) and this binding agreement shall continue for 7/8 consecutive months. After this period, this agreement will automatically continue on a month-to-month basis unless you terminated it with at least 20 (twenty) business days’ written notice or if specified otherwise during the initial registration.
  3. Despite clause 3. you may terminate this Agreement at any time by giving Biolink at least 20(twenty) business days’ notice in writing. If you do choose to terminate this Agreement during the Initial period, you will be subject to pay the balance of your contract. The balance of your contract is your monthly fee amount times by the remaining months of your contract. Any amounts outstanding to Biolink will also be added to the cancellation cost. (Initial Here)
  4. In case of late arrivals, your session time will be shortened so as not to impact the next session.
  5. In the event of canceling a session, both parties must be notified a day before the session. The session will be rescheduled. If no cancellation was received in time, the full amount per session will be due.
  6. 28 hours MUST be completed within every 8-month period.
  7. It is the responsibility of the participant/parent/guardian to reschedule the missed session.
  8. It might not be possible to have an in-depth discussion regarding the participant’s progress during session time, so please make an appointment with the facilitator in advance.
  9. All parties should understand that no improvement can be guaranteed if sessions are not attended as agreed upon in the treatment plan of the participant. Failure to follow the treatment plan as prescribed will impact the outcome and success of the sessions.
  10. Biolink will not be held responsible for unfavourable results due to participants not complying with instructions during sessions, not attending sessions as prescribed, or not completing the prescribed amount of sessions.
  11. I hereby give permission that photographs of the participant and testimonies by the client, parents, or guardians may be used for advertising purposes.

For example: J.M.

The town or city you’re in.

Your signature
Sign here with your finger or mouse

Signed on .

All done? Send it to your centre.

We’ll send it to your Biolink centre. You can download a signed PDF copy for yourself too.