PURPOSEFUL PLACEMENT

Please complete this section in full and be as honest as possible. The detail you provide is essential to successfully match a Purposeful Placement Dog to you.

Applicant Living Circumstances

Please provide details of all people living in the household (even temporarily)

Background Information

This section requires you to review and sign important consent, privacy, and release of information statements.

Please have a support person with you if required and engage in any self-care you need to feel well.

Assistance Dogs Australia is not a crisis service; however, please contact Lifeline on 13 11 14 for emotional support or 000 in an emergency.

Information Gathering, Confidentiality & Consent

The Applicant:

• has reviewed the information and meets the criteria for an Assistance Dogs Australia Purposeful Placement Dog.
• understands that Assistance Dogs Australia will only accept applications that are completed in full with supporting documentation submitted within two (2) weeks.
• understands that Assistance Dogs Australia reserves the right to advise that an applicant is not suitable for an Assistance Dogs Australia Purposeful Placement Dog at any time throughout the application process.

Information Gathering – The Applicant understands and agrees that:

• providing information about themselves, their family, and/or their support people is voluntary, and it is their decision to share personal information with Assistance Dogs Australia.
• personal information is gathered as part of ADA’s assessment, dog matching, contracts, training, program reviews, and general Assistance Dogs Australia program development and quality improvement.
• Assistance Dogs Australia may record portions of in-home suitability assessments (video/photos) to optimise our dog matching process. No images or footage will be captured without prior knowledge/consent at the time.
• personal information is kept securely, and all applicants are protected by the Assistance Dogs Australia Privacy Policy.
• Assistance Dogs Australia is committed to, and complies with, the appropriate legislation to keep information private and confidential, including the Australian Privacy Act 1988 (amended 2014).
• at any stage they are entitled to apply to access their personal information retained by Assistance Dogs Australia, subject to exceptions in the relevant legislation or by Assistance Dogs Australia management.
• quality improvement or evaluation findings undertaken by Assistance Dogs Australia may be made public (e.g., as a report or journal article). However, if findings are made public, the applicant, their family, and/or support persons will not be personally identified in any way.
• Assistance Dogs Australia is subject to audits from governing bodies such as Assistance Dogs International (ADI) and the National Disability Insurance Agency (NDIA/NDIS), and information may be reviewed for these purposes.
• Assistance Dogs Australia works with secondary bodies for ongoing research. Assistance Dogs Australia will seek permission to share personal information prior to the commencement of any research. Participation is optional and will not impact the application process.

Confidentiality Limits

All personal information gathered by Assistance Dogs Australia will remain confidential except when:

• it is subpoenaed by a Court, or disclosure is otherwise authorised by law.
• failure to disclose the information would, in the reasonable belief of an Assistance Dogs Australia staff member, place the applicant, an animal, or another person at serious risk to their life, health, or safety.
• prior approval has been obtained to disclose the information.

I have read, understood, and agree to the points set out above.

Rights & Responsibilities

Applicant/Recipient Rights

• All applicants will be considered regardless of race, gender, religion, and/or sexual orientation.
• Applicants and, if successful, recipients have the right to be treated with respect and dignity in all interactions with staff, volunteers, and other constituents of Assistance Dogs Australia.
• If successful, recipients have the right to receive an educational program to learn how to handle the dog at home.
• If successful, recipients have the right to receive a physically sound dog. Assistance Dogs Australia dogs will be neutered or spayed prior to being placed.

Recipient Responsibilities

• Recipients will be responsible for all associated costs, including veterinary care, feeding, worming, and grooming, if they are successful and have taken possession of the Purposeful Placement Dog.
• Recipients are responsible for their travel and any associated costs for the purpose of training.
• Recipients must be responsible for the health and wellbeing of the Purposeful Placement Dog.
• Recipients must register their dog with their local council.
• Recipients must inform Assistance Dogs Australia if they can no longer own the dog, prior to rehoming the dog.

Assistance Dogs Australia’s Dogs Rights

All animals within Assistance Dogs Australia’s programs have inalienable rights for the entirety of their life, including the following:

• The right to be cared for in a manner that meets Assistance Dogs Australia's welfare standards.
• The right to be well treated and not be mistreated, ill-treated, or cruelly treated.
• The right to positive and considerate training techniques.
• The right to protection from physical, verbal, and other attacks.
• The right to quality food, water, and shelter indoors in the family home.
• The right to proper veterinary care.
• The right to adequate rest periods.
• The right to adequate play periods.

I have read, understood, and agree to the points set out above.

Terms of Agreement

• Assistance Dogs Australia assesses applicants for suitability and merit.
• After completing an application, there is no guarantee of acceptance.
• Assistance Dogs Australia reserves the right to advise applicants that they are not suitable for a dog at any time.
• Providing false or misleading information to Assistance Dogs Australia can result in dismissal from the program.
• If successful, the Purposeful Placement Dog will not be used by the applicant, or any other party, for the purposes of begging, busking, or in the film, television, or entertainment industry without the written consent of Assistance Dogs Australia.
• The applicant understands that upon successful completion of training, guardianship of the dog will be transferred from Assistance Dogs Australia to the applicant.
• Assistance Dogs Australia's program is voluntary, and the applicant has decided to participate in the program.
• The applicant understands that engaging with Assistance Dogs Australia may involve interaction and play with dogs, including physical contact, feeding, and grooming. Assistance Dogs Australia staff take all reasonable steps to ensure the safety of individuals and dogs. However, there are inherent risks associated with working with animals, such as scratches, swipes, knocks, bites, barking, zoonotic diseases, and the presence of animal fur and saliva on your person.
• If successful, the recipient must be prepared to comply with the Terms of Agreement.

I have read, understood, and agree to the points set out above.

Final Checklist

Purposeful Placement Dog Program Overview

• I have read and understand the information provided.
• Purposeful Placement Dog Program Signature:

Applicant Information

• I have completed the applicant information in full and all information provided is true and correct.

Consent & Release of Information