- Select - Miss Ms Mrs Mr
Date of Birth
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
- None - Australia
Street / Mailing Address
Suburb / Postcode
Uniform size (polo short and jacket)
- None - Ladies 8 Ladies 10 Ladies 12 Ladies 14 Ladies 16
- None - Mens S Mens M Mens L Mens XL Mens XXL
Other size, please specify:
Other, please specify:
If your property is rented or is public housing have you advised your landlord/agent of your intent to apply for a CCCP dog and are they are aware CCCP dogs require access to inside the home?
In what profession/area is the bulk of your experience?
Please outline any formal qualification/ training you have completed:
Please outline any interests or hobbies you feel may support your application:
Please outline any recent or previous volunteer experience you have:
I would like to host a dog and become a Therapy Dog Handler.
Fantastic! If you are able to commit to at least 1 day per week at a nominated courthouse and you have the capacity to care for a Therapy dog in your home we would love to have you on board!
I would like to become a Therapy Dog Handler, am unable to host a dog full time but can do temporary care.
If you are able to volunteer as a Therapy dog Handler and you can care for a dog every now (when a full time Host goes on holidays, etc.) then this may suit you.
I would like to become a Therapy Dog Handler but am unable to host a dog at all.
In the instance you would like to volunteer as a Therapy dog Handler but are unable to Host a dog in your home we may be able to offer an alternative role. If you are willing to commit your time to courthouse visits and are able to collect and securely transport a Therapy dog who is being Hosted by another volunteer to the courthouse then this may be the role for you.
I currently own a dog from GDNSW/ACT and am interested in becoming a Therapy Dog Handler.
If you Puppy Raised a dog for Guide Dogs NSW/ACT and it was deemed unsuitable to be placed with a client in one of our programs due to a minor health or temperament/behavioural concern and you would like to volunteer, please contact us further to discuss.
I would like to volunteer with my own Labrador or Golden Retriever.
Although the majority of the dogs used in the CCCP are from Guide Dogs NSW/ACT, should you wish to have your dog assessed for the program we would be happy to discuss this further with you.
What is your preferred Courthouse location?
Which days can you commit to for weekly Courthouse visits for 1.5 hours between 9am – 12pm?
Which days can you commit to for weekly Courthouse visits 9am – 10.30am?
Are you able to travel to Parramatta Justice Precinct for training?
Are you able to travel to the Guide Dog Centre in Glossodia for training?
Are you able to collect supplies from a Puppy Development Advisor in your local area?
Are you able to attend training days with a Puppy Development Advisor in your local area?
Are you able to travel to a nominated local location for training?
Are you able to collect supplies from your local pet store?
Would you be willing to attend your local dog training club to maintain handling skills?
Other, please specify
Do the people you live with support your application?
Do you or does anyone living at your home have an allergy to or fear of dogs?
Do you have a dog/s living at your home?
Please describe (other dog/s living at home):
If yes are they sociable with people?
If yes are they sociable with other dogs?
Do you have a cat/s living at your home?
Please describe (cat/s living at home):
If yes are they accepting of dogs?
*Please note that not all of our dogs have been socialised or exposed to cats. If you own a cat there will be a settling period whilst the dog and cat learn to co-exist. This can take weeks to months.
**If you own small pets (guinea pigs, rabbits, birds, etc.) please ensure they kept are kept in a dog- safe enclosure.
Where will the Dog sleep?
Where will the Dog be toileted?
What areas will the dog be allowed inside the home?
Will the dog be left unsupervised at any time?
Please describe when and how long the dog will be left unsupervised:
Who will be primarily responsible for the dog's exercise?
Where and how will the dog be exercised?
Do you have a securely fenced dog proof house yard?
Do you have secure dog proof gates to your yard?
Do you have a sheltered area near or connected to the home?
If no shelter will be built, is there a dog door suitable for a Labrador?
Do you reside in or visit an area known to have paralysis ticks?
Do you have access to veterinary care?
If yes, which veterinary clinic?
Are you able to transport the dog to the vet for both annual check-ups, preventative treatments, and in cases of emergency?
Do you have current or previous dog handling experience?
Please describe previous dog handling experience:
Are you physically capable of handling an approx. 30 - 35 kilo dog?
Have you or any house hold members:
a) been investigated by any government, semi government, administrative, fiscal, judicial or other body, department, commission, authority, tribunal, agency or entity in relation to animal cruelty; or
b) been in breach or alleged to have been in breach of the any legislation or local by-laws relative to the keeping of dogs, cruelty against animals or animal welfare.
Have you or any house hold members options
Courts can be high stress environments and some encounters may be distressing for various reasons. Not all court users will be comfortable with or want to engage with a Therapy Dog. Additional training will be given to all successful applicants to support their roles. It is important however to consider what impact, if any, attending court may have on your personal wellbeing.
Do you have the capacity to remain composed in situations you may find uncomfortable?
Would taking on such a role put you at risk of triggering or exacerbating existing mental health issues?
Are you willing to seek assistance or advice to debrief should you feel distressed?
Once your application has been approved you will be required to provide current Working With Children Check and National Police Check certificates. On approval you will receive an email containing links so that you can apply online. Full certificates will be required, not just numbers, so that the certificates can be verified as per Victim’s Services requirements.
Is there mobile phone reception where you live?
Is there safe and secure parking near your residence?
If you smoke, are you willing to cease smoking whilst in company of Guide Dogs staff?
Do you or anyone residing in your home have a condition or illness which may threaten the safety and health of Guide Dogs NSW/ACT staff?
If yes,please describe:
Guide Dogs NSW/ACT staff reserve the right to discontinue service if they feel threatened or unsafe at any time.
Guide Dogs NSW/ACT is committed to protecting the personal information of our clients, members, donors, supporters, customers and other individuals we deal with. We recognise that individuals have a right to control how their personal information is handled. Providing personal information is an act of trust that we take seriously.
Personal information is information about you, such as your name, contact details and records of your dealings with us. Personal information may in some cases include sensitive information, such as health information or membership of a professional or trade association.
For more details please see our full policy on http://www.guidedogs.com.au/privacy-policy
I understand that Guide Dogs NSW/ACT assesses all applications on the merit of each case and has the right to determine the suitability, or not, for applicants to be allocated a Therapy Dog as a Host or become a Therapy Dog Handler.
By typing in your full name below and submitting this form, you verify that all information you provided in this form is true and accurate.
Applicant's Full Name