for each ACTIVITY, SERVICE and MODALITY, etc. you offer.
Refer to our List of Mainstream Activities on our Activities, Equipment and Devices Page.
Our new Insurance Package includes Professional Indemnity which requires you to identify the Services you offer for which you expect to have Insurance Cover and needs to be initially Identified, Listed and Supported 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 when purchasing Insurance with your Membership.
Your responses can be inserted in each line below the question, saved and sent.
Please download, complete and return your completed form to firstname.lastname@example.org asap.
Please use a New Form or Sheet for every Activity regardless of you charging for that service or providing it for Free.
Note: The Alliance Policy in regards to Question 17 and 18 is that a Clearance or Exemption is required.
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 each of the listed activities.
Last updated July 15, 2019
Questionnaire – To download the Questionnaire click HERE
|1||Full Name and Membership Number / e.g. John Smith #99|
|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 listed on the Alliance Website?|
|6||Is there a specific website linked to this Service?|
|7||Were you trained or did you develop this Service with experience?|
|8||How long have you been providing this Service?|
|9||Are there any prior qualifications to study this Service?|
|10||Are there any practicing hours to qualify?|
|11||Are there any training requirements for this Service?|
|12||Do you have a Certificate of Qualification? From whom and where?|
|13||Do you need to attain Annual Professional Points?|
|14||Is there an accrediting professional body for this Service?|
|15||Do you have 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 provide this Service as – Veterinary Services?|
|20||When providing this Service do you use any – Equipment? What?|
|21||When providing this Service do you use any – Devices? What?|
|22||Is there any risk to anyone when providing this Service?|
|23||Have you a Risk Assessment for this Service? Do you need one? Please provide.|
|24||Do you need assistance to prepare a Risk Assessment and Safety Plan?|
|25||Do you provide this Service – as a Mobile Activity?|
|26||Do you provide this Service – for/as Fund-Raising? Where?|
|27||Do you provide this Service – in your State? Where?|
|28||Do you provide this Service – interstate? Where?|
|29||Do you provide this Service – overseas? Where?|
|30||Have you a Working With Children Clearance or Exemption? please provide.|
|31||Have you ever been refused Insurance for this Service? Details please.|
|32||Have you been convicted of an offence for this Service? What?, When?|