Membership Application Form - New Members

PLEASE NOTE: ONLY COMPLETED APPLICATIONS WITH ALL DOCUMENTATION REQUIRED WILL BE PROCESSED

Membership

PERSONAL DETAILS

Surname:*

First Name/s:*

Postal Address:*

Postal Address Line 2:

Suburb:*

State:*

Postcode:*

Phone (Home):*

Mobile:

Work:

Email:*

How did you hear about PTPA?

Website Direct Mail/Email Referred by PTPA member Other

PROFESSIONAL QUALIFICATIONS

Which one of the following professions are you qualified? (select one, based on your undergraduate degree qualification)

WORKPLACE AND EMPLOYMENT

Please tick all that apply

Private practice workplace - privately owned practice; self-employed alone or with others

Not for profit workplace

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

Please give details of current workplace/s:

Please describe your theoretical approach when practising Play Therapy:

PLAY THERAPY CLINICAL SUPERVISION

Have you completed 30 hours of play therapy clinical supervision?

Yes No

Client Contact Hours

Have you completed 300 hours of client contact hours?

Yes No

Play Therapy Supervision Training

Have you completed a training course in play therapy supervision?

Yes No

Have you completed a minimum of 3 years membership with PTPA?

Yes No

Have you completed a minimum of 2 days of supervision related training?

Yes No

Post Graduate Play Therapy Studies

Have you completed any post graduate play therapy studies?

Yes No

CURRENT WORKING WITH CHILDREN CHECK OR NATIONAL POLICE CHECK

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? (Police Clearance must be current within the last year of the date of your application)

Yes No

PROFESSIONAL INDEMNITY INSURANCE

Required for play therapists in private practice and for those employed by a workplace

Professional Indemnity and Public Liability Insurance cover in private practice, of a minimum of $10,000,000.00
Professional Indemnity and Public Liability Insurance cover provided by a workplace or organisation

COMPLAINTS AND LEGAL MATTERS

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

Yes No Unknow

If yes, what was the outcome of this?

DECLARATION FOR MEMBERSHIP

In making this application I acknowledge that if accepted as a Play Therapy Practitioners Association Member that in my play therapy work with children and families, I will comply with all relevant PTPA Best Practices Guidelines as stated by the Association.

I CONFIRM THAT:

1. I do not have a criminal record that may prejudice the interests of children.

2. I have not been dismissed from employment on the grounds of professional misconduct.

3. I have not been refused membership of a professional body or register in a related field on the grounds of professional misconduct.

4. I agree to adhere to the PTPA renewal requirements for continuing clinical supervision and clinical practice.

5. The information detailed in this membership application form is true to the best of my knowledge and does not contain any false or misleading information regarding my experience, qualifications, practice, membership or identity.

6. I am aware my information contained and provided in this application will be held by PTPA.

7. Should a complaint be received by PTPA in regards to my conduct, that I will comply with all investigation processes undertaken by the Association and will be advised of the outcome in a timely manner.

8. Should a complaint be lodged against me with the mental health association, body or board of which I am a member or registered with, I agree to inform PTPA of the outcome of the complaint within 14 days of the decision.

9. I understand and accept that the Play Therapy Practitioners Association reserves the right to terminate my membership if there is a breach of any of the above conditions or if there are ethical concerns about a provisional clinical member’s work.

PAYMENT INFORMATION

Documents Required:

Evidence of under graduate degree
Evidence of Post Graduate Play Therapy Studies
Copy of Working with Children Check (Blue Card)
Evidence of clinical supervision hours
Evidence of client contact hours
Evidence of professional indemnity insurance
Evidence of play therapy supervision training

PAYMENT INFORMATION

AUD$85.00 - Affilliate AUD$125.00 - Associate AUD$150.00 - Registered Play Therapist AUD$175.00 - Registered Play Therapist - Supervisor

All payments must be made by direct deposit to the following account
(these details will also be emailed to you after submission):

Account Name: Play Therapy Practitioners Association Inc
BSB: 064-192
Account Number: 1007 1563
Message/Reference: Please use your surname for payment reference