Insurance Questionnaire

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 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
Thank you.

Questionnaire – To download the Questionnaire click HERE

1Full Name
2Contact Email and Phone (Mobile)
3Are you a Service Provider or Facilitator ?
4Name and brief description of the Service / Activity / Modality
5Is this a variation of a Mainstream Activity listed on the Alliance Website?
6Is there a specific website linked to this Service?
7Were you trained or did you develop this Service with experience?
8How long have you been providing this Service?
9Are there any prior qualifications to study this Service?
10Are there any practicing hours to qualify?
11Are there any training requirements for this Service?
12Do you have a Certificate of Qualification? From whom and where?
13Do you need to attain Annual Professional Points?
14Is there an accrediting professional body for this Service? 
15Do you have current accreditation for this Service? From who?
16Do you offer this Service to – Adults?
17Do you offer this Service to – Children – with or without supervision?
18Do you offer this Service to – Vulnerable people – disabled, ?
19Do you provide this Service as – Veterinary Services?
20When providing this Service do you use any – Equipment? What?
21When providing this Service do you use any – Devices? What?
22Is there any risk to anyone when providing this Service?
23Have you a Risk Assessment for this Service? Do you need one? Please provide.
24Do you need assistance to prepare a Risk Assessment and Safety Plan?
25Do you provide this Service – as a Mobile Activity?
26Do you provide this Service – for/as Fund-Raising? Where?
27Do you provide this Service – in your State? Where?
28Do you provide this Service – interstate? Where?
29Do you provide this Service – overseas? Where?
30Have you a Working With Children Clearance or Exemption? please provide.
31Have you ever been refused Insurance for this Service? Details please.
32Have you been convicted of an offence for this Service? What?, When?