Register - Animal Therapies Ltd | Animals Helping Humans

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REGISTERED NAME OF ORGANISATION : *

BUSINESS STATEMENT(LIMIT TO 90 CHARACTERS) *

First Name

Last Name

CONTACT NUMBER *

WORK NO :

POSTCODE : *

STATE : *

ADDRESS OF ORGANISATION: *

WEBSITE:

EMAIL :

DATE OF APPLICATION :

NDIS REGISTERED?

POLICE BACKGROUND CHECKED?

Medicare Provider

REGISTERED TO WORK WITH CHILDREN?

MENTAL HEALTH FIRST AID CERTIFIED?

QUALIFIED TO WORK WITH PEOPLE WITH DISABILITIES?

Home Suburb

DISTANCE YOU WILL TRAVEL (Km)

IS YOUR SERVICE MOBILE? YES/NO

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PLEASE TELL US ABOUT THE TYPE OF SERVICE YOU PROVIDE – *Tick all relevant boxes

Type of Service Provided

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I provide Animal-Assisted Therapy (AAT) which incorporates animals and a qualified health professional as part of a specific therapeutic plan to assist people recover from a physical, cognitive or psychological condition.

Specify Type of Animal:

I provide Animal - Assisted Activities (AAA) which incorporates a trained handler and animal team to provide comfort, distraction, motivation & stimulation to people in hospitals, workplaces, schools, universities, aged care residences, prisons and mental health facilities among other institutions.

Specify Type of Animal:

I provide Animal-Assisted Learning (AAL) which incorporates animals and a facilitator within a structured training program to assist an individual or a group to achieve predetermined learning outcomes. This can include a dog participating in a child’s reading program, a herd of horses working with a group or other learning programs involving other animals.

Specify Type of Animal:

I provide or train Assistance Animals (often dogs “AD”) are trained to perform one or more tasks to alleviate their handler’s condition. Assistance animals have a legal right to access public places. They support people with a disability in accessing various aspects of personal and public life..

Specify Type of Animal:

Please specify professional qualifications below if not listed above

List the name of any AAI or AA training organisations you have trained under and any other animal related memberships held

Animal Certifications

*Service Provider Minimum Requirements

Please complete the following information in order for your application
to be considered for approval.

If approved your services will be listed on the Animal Therapies Ltd database

Requirement

Holds a current public liability insurance policy.

Compliance Information

I hold a current insurance policy.

Name of the insurer

Insured amount:

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Holds a current professional indemnity insurance

I hold a current insurance policy.

Name of the insurer

Insured amount:

Is currently registered for tax with the Australian Tax Office

My organisation is currently registered for tax.

ABN:

If you are an Allied Health Professional or professional animal trainer you must hold a current professional membership with the relevant peak body including professional liability insurance.

If applicable, please state which peak body you are a member of:

Uses positive training methods when training animals

I agree to abide by the ATL Code of Ethics.

RSPCA Duty of Care to Your Animals 1. Freedom from hunger and thirst: by ready access to fresh water and a diet to maintain full health and vigour. 2. Freedom from discomfort: by providing an appropriate environment including shelter and a comfortable resting area. 3. Freedom from pain, injury or disease: by prevention through rapid diagnosis and treatment. 4. Freedom to express normal behaviour: by providing sufficient space, proper facilities and company of the animal’s own kind. 5. Freedom from fear and distress: by ensuring conditions and treatment which avoid mental suffering.

I agree to comply with the RSPCA guidelines and duty of care towards all animals in my service.

Only fill in if you are not human

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Service Provider Information

PLEASE TELL US ABOUT THE TYPE OF SERVICE YOU PROVIDE – *Tick all relevant boxes

Type of Service Provided

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*Service Provider Minimum Requirements

Requirement

Compliance Information

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