Application for Associate Membership

This form begins the process for registering to become a member of the Australian Play Therapists Association, Inc. It includes collection of essential personal information as well as assessing the eligibility criteria for membership.

All information is stored securely and will only be used for the purpose of your APTA membership.

* Indicates required question

Email *

Postal Address *

First Name *

Last Name *

Proof of name change

Please attach a copy of proof of name change (e.g. marriage certificate or change by depol) if you have had a change of name and have provided documents with different names.

Upload up to 5 supported files. Max 10 MB per file.

Contact Phone Number *

Postcode

State/Territory

How did you hear about us? *

If you heard about us another way, please specify

Qualifications

* Indicates required question

If you are qualified for another profession, please specify

Proof of qualification

Please attach an officially certified copy of your professional mental health qualification.

Upload up to 5 supported files. Max 10 MB per file.

Workplace and Employment

& Therapy Practice

* Indicates required question

Where do you practice therapy? *

Private practice

Not-for-profit

Medical workplace – private or public hospital or clinic

Public workplace – State or Commonwealth government service

School workplace - private or public; K-12

Educational/University workplace - private or public; instruction, administration, research, etc.

Other:

If other, where else do you practice therapy?

Details about your current workplace *

Professional Registration

& Supervision

* Indicates required question

Do you hold a current registration with a relevant mental health association or board? (e.g. ACA or PACFA for counsellors, AASW for social workers, AHPRA for psychologists and OTs, ANZACATA for creative arts therapists) *

Yes

Who is this registration with?

What is your registration number?

Proof of registration

Please attach a copy of up-to-date registration or membership with the relevant mental health association/body or board.

Upload up to 5 supported files. Max 10 MB per file.

Please provide evidence of your supervisor's registration with their governing bodies (e.g, ACA, PACFA, AASW, AHPRA for their primary mental health profession, and APTA, APPTA, APT (US) or BAPT (UK) for their play therapy registration) *

Please ensure that you supervisor is either a Registered Play Therapist or a Registered Play Therapist Supervisor

Upload 1 supported file. Max 10 MB.

Working with Children Clearance

* Indicates required question

Do you hold a current Working With Children Check or Police Clearance? *

Yes

Do you hold a current Working With Children Check or Police Clearance lodged and accepted according to legislation within the state/country in which you work in?

Current Working with Children Check or National Police Check

Please attach a certified (see APTA’s lists of eligible certifiers) copy of documentation of a current Working with Children Check and/or National Police Check as required by Australian individual state law.

Upload 1 supported file. Max 10 MB.

Personal Indemnity Insurance

Is your Private Indemnity Insurance:

For a private practice, and at a minimum of $10,000,000.00

Provided by a workplace or organisation

Personal Indemnity Insurance Certificate

Please attach a copy of professional indemnity insurance certificate of currency or letter from your workplace

Upload up to 5 supported files. Max 10 MB per file.

Complaints and Legal Matters

* Indicates required question

Have any formal complaints been made against your professional conduct, or have you been involved in legal matters regarding your professional conduct? *

Yes

If yes, what was the outcome?

Declaration

* Indicates required question

If your application will be accepted, do you agree to the following? *

All information given here is accurate to the best of my knowledge.

I am aware my information contained and provided in this application will be held by APTA, and only be used for the purpose of my membership.

I will fully comply with the APTA Best Practice Guidelines, and the Complaints Procedures and the Code of Ethics of the mental health, board or association of which I am also a member.

I will engage in regular play therapy supervision.

I am aware of and understand the annual renewal requirements for Associate Membership with APTA, as published on the APTA website.