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Public Access
Application.

This form is detailed and will require time to complete. Please include as much information as possible and make sure all information provided is true and correct. The more detail available, the more efficiently we will be able to process your application.

Application

About you

Date of birth

About your medical Condition/s

Emergency Contact Information

Assistance Dog Details

Dog's date of birth
sex
Male
Female
Is your dog neutered?
Yes
No
Has your assistance dog done any public access work?
yes
no

General information

Have you previously applied to any other assistance dog organisation?
Yes
No
Are you applying to attend university?
Yes
No

Application terms and conditions

In line with Data Protection legislation, we will never share your personal information with a third party. Please tick this box if you are happy for us to contact you, you can opt out at any time.
Yes
I agree to submit evidence of disability, either PIP/DLA or Dr's/Consultants Letter
Yes
I confirm that I will provide a vet report proving that my assistance dog is fit and healthy
Yes
I confirm that my dog is up to date with its vaccinations or has been titre tested and will remain so during the duration my dog is qualified as an ADAA dog
Yes
I confirm that my dog is insured minimum 3rd party and will remain insured during the duration my dog is qualified as an ADAA dog. Proof will be required.
Yes
I agree to submit video evidence with my application of any trained tasks that are unable to be demonstrated during assessment. i.e. loading the washing machine, seizure alert.
Yes
I confirm that in submitting this application I agree to ADAA's Code of Ethics and Equipment Rules and that I will not use any aversive or punitive methods, tools or equipment on my assistance dog, when my dog is working or off duty.
Yes
I confirm I will not bring the charity's name into disrepute through social media or other forms of electronic communication
Yes
I understand that there is a fee for ADAA Assessment that must be paid in full upon application
Yes
I understand that on passing the Public Access assessment ADAA will only qualify each team for 1 year. If you wish to remain an ADAA qualified team, you will need an annual re-assessment, and this will be charged at £52 annually
Yes
ASSESSMENT TYPE - please choose one

Declaration

I declare that the information provided in this application is true and correct. I understand that any dishonesty may result in my application being refused or certification being withdrawn at a later date.
Yes
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