for each ACTIVITY, SERVICE and MODALITY, etc. you offer.
Refer to our List of Mainstream Activities on our Activities, Services, Modalities Page.
Our Membership PLUS Package requires you to identify the Services you offer for which you expect to have Cover and support, and needs to be initially Identified and Listed by the Alliance. Your responses are noted in good faith and will be used to support you, should it ever be needed.
This Questionnaire is required for EACH MODALITY / ACTIVITY when purchasing Membership PLUS.
Your responses can be inserted in each line below the question, saved and sent.
Please download, complete and return to firstname.lastname@example.org asap.
Please use a New Form or Sheet for every Activity even if you provide the service for free.
The Alliance must be confident that your responses can be verified and can be used to support you should you become a person of interest in any legal, claim, complaint or liability situation and thereby your response becomes a legal document.
Once your Activities have been listed a Certificate of Service will be emailed to you as a record. The Certificate of Service entitles you to Constitutional Freedom to Practice for each of the listed activities.
Questionnaire 2021 v02
|1||Full Name and Membership Number (if known)|
|2||Contact Email and Phone (Mobile)|
|3||Are you a Service Provider or Facilitator ?|
|4||Name and brief description of the Service / Activity / Modality|
|5||Is this a variation of a Mainstream Activity already listed on the Alliance Website?|
|6||Is there a specific website linked to this Service?|
|7||Were you taught or did you develop this Service with experience?|
|8||How long have you been providing this Service?|
|9||Are there: – any pre-requisite qualifications to study for this Service?|
|10||Are there: – any practicing hours to qualify or maintain qualifications?|
|11||Are there: – any training requirements for this Service?|
|12||Have you: – a Certificate of Qualification? From whom and where?|
|13||Do you need to attain Annual Professional Points?|
|14||Is there an accrediting professional parent body for this Service?|
|15||Have you: – any current accreditation for this Service? From who?|
|16||Do you offer this Service to: – Adults?|
|17||Do you offer this Service to: – Children – with or without supervision?|
|18||Do you offer this Service to: – Vulnerable people – disabled, ?|
|19||Do you offer this Service as: – Veterinary Services?|
|20||When providing this Service do you use any: – Consumable Goods? What?|
|21||When providing this Service do you use any: – Devices? What?|
|22||Is there any risk to anyone before, during or after providing this Service?|
|23||Have you: – a Risk Assessment for this Service? Please provide.|
|24||Do you provide this Service: – in a Leased / Rented / Owned Facility?|
|25||Do you provide this Service: – as a Mobile Activity?|
|26||Do you provide this Service: – at Psychic Fairs? Where?|
|27||Do you provide this Service: – in your State? Where?|
|28||Do you provide this Service: – interstate? Where and for how long?|
|29||Do you provide this Service: – overseas? Where and for how long?|
|30||Have you: – a Working With Children Clearance or Exemption? please provide.|
|31||Have you: – a Mental Health Care Qualification? please provide.|
|32||Have you: – a First Aid Certificate? please provide.|
|33||Have you: – ever been refused Insurance for this Service? Details please.|
|34||Have you; – ever been convicted of an offence for your Services? What?, When?|