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No Claim Absence Form

Client Details

First Name*
Please enter your first name.
Please enter your first name.
Last Name*
Please enter your last name.
Please enter your last name.
Email*
Please enter your email.
Please enter your email.

Educator Details

First Name*
Please enter your Educators first name.
Please enter your Educators first name.
Last Name*
Please enter your Educators last name.
Please enter your Educators last name.
Email*
Please enter your educators email.
Please enter your educators email.

No Claim Absence Details

Reason for Absence*
Field is required!
Field is required!
Who is taking the holiday?*
Field is required!
Field is required!
Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!
Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!
I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

Who is unwell?*
Field is required!
Field is required!
Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!
Is your Educator experiencing an illness that is the result of an attended session of care?*
Field is required!
Field is required!
Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!
Is your Educator experiencing an illness that is the result of an attended session of care?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!
I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

Was the Educator injured during a session of care, not due to Educator negligence?*
Field is required!
Field is required!
Please describe the incident which led to the injury*
Field is required!
Field is required!
Please enter the date the injury occurred*
Field is required!
Field is required!
Please enter the FIRST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!
Please enter the LAST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Please describe the incident which led to the injury*
Field is required!
Field is required!
Please enter the date the injury occurred*
Field is required!
Field is required!
Please enter the FIRST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!
Please enter the LAST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

Please enter the FIRST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!
Please enter the LAST date of Educator consequential unavailability due to injury recovery (if applicable)
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

Is this a Family or Educator absence?*
Field is required!
Field is required!
What is the reason for the absence?*
Field is required!
Field is required!
Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

What is the reason for the absence?*
Field is required!
Field is required!
Is this one date or a range of dates?*
Field is required!
Field is required!
Please select one date*
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!
Start date*
Field is required!
Field is required!
End date*
Field is required!
Field is required!
Your Educator receives a nominal payment for each successfully claimed absence. Would you like us to claim this absence so that your educator receives this payment?*
Field is required!
Field is required!

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

*CLAIMABLE ABSENCE*

Please submit this form for our records. If you have any questions, please be in contact.

We thank you for holding the same values as our Agency and agreeing to claiming this absence, resulting in your Educator receiving this payment. Showing gratitude to your Educator in this way aligns strongly with our business culture and values.

I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!
I confirm that I have discussed this absence with the above named educator and they have agreed to submit this absence as a 'No Claim Absence' and understand they will NOT receive an absence payment*
Field is required!
Field is required!

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

You are confirming that both the Family and the Educator agree that the no claim criteria has been met. Where the Educator and Family’s opinions differ, this form should not be submitted, instead please get in contact with our office team for support so that we can assist with reaching an amicable solution.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

This form cannot be submitted unless both the family and educator have discussed and agreed that the no claim criteria has been met. Where the Educator and Family’s opinions differ, ALHCA will assist with reaching an amicable solution, please get in contact with our office team for support.

Submit