Application form
Section 12(e) — Nature Conservation (Administration) Regulation 2006
OFFICIAL USE ONLY
DATE RECEIVED
Rehabilitation permit
FILE REF
Important information for applicants
PROJECT REF
COMPLETE FORM
CORRECT AA
COMPLETE FEE
ADMINISTERING DISTRICT
ENTERED BY [SIGNATURE]
DATE
This form is to be used to apply for a rehabilitation permit. Information
requested will enable your application to be processed as prescribed by the
Nature Conservation Act 1992. Your application must be assessed and a
permit granted by the chief executive before you can proceed with the
proposed activity. Your application may take up to 40 business days to
process.
The permit holder is required to release the animal/s held under this permit into
a prescribed natural habitat in the wild as soon as the animal is
rehabilitated/fit/old enough and able to live in that habitat.
Applicants must be able to demonstrate their skills, knowledge and ability
before being issued with a permit. The chief executive can refuse to grant a
rehabilitation permit if the applicant does not satisfy the chief executive that
they can carry out the activities under this authority.
Before completing your application please read the information materials
included with your application kit and contact Permit and Licence
Management on 1300 130 372 to discuss any issues. Before lodging this
application you should be familiar with the requirements of the Nature
Conservation Act available on the Office of the Queensland Parliamentary
Counsel website http://www.legislation.qld.gov.au. If you have queries about
how to complete this form correctly or need guidance, contact Permit and
Licence Management on 1300 130 372.
Applicant information
A wildlife authority may only be granted to an individual or corporation (only if the corporation has an office
within Queensland). Please tick the appropriate box:
AN INDIVIDUAL
Complete Section 1 applicant details — then complete sections 3 to 11
A CORPORATION 
Complete Section 2 applicant details — then complete sections 3 to 11.
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Application form
Rehabilitation permit
1. Applicant details for an individual
APPLICANT’S FAMILY NAME
TITLE
APPLICANT’S GIVEN NAME/S
DATE OF BIRTH
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
FACSIMILE
POSTAL ADDRESS (WRITE ‘AS ABOVE’’ IF SAME AS RESIDENTIAL ADDRESS)
POSTCODE
2. Application details for corporations
REGISTERED LEGAL ENTITIY NAME (NOT A BUSINESS TRADING NAME)
TRADING NAME/S (IF APPLICABLE)
REGISTERED BUSINESS ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
FACSIMILE
EMAIL
WEBSITE
POSTAL ADDRESS (WRITE ‘AS ABOVE’ IF SAME AS BUSINESS ADDRESS)
POST CODE
ABN / ACN / AN, OR TITLE AND SECTION OF LEGISLATION UNDER WHICH CORPORATION HAS LEGAL STATUS
NAME OF PRINCIPAL OF CORPORATION
SIGNATURE OF PRINCIPAL OF CORPORATION (or person authorised to sign on their behalf)
DATE
Details of nominated person in charge where the licensed activity is to be undertaken
NOMINATED CONTACT PERSON’S FAMILY NAME
TITLE
NOMINATED CONTACT PERSON’S GIVEN NAME/S
DATE OF BIRTH
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Department of Environment and Heritage Protection
Application form
Rehabilitation permit
RESIDENTIAL ADDRESS (NOT A POST OFFICE BOX)
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
FACSIMILE
POSTAL ADDRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL ADDRESS)
POSTCODE
Note: In accordance with the Code of Practice — Care of Sick, Injured or Orphaned Protected Animals In
Queensland, when applying for a group permit the Code states that ‘membership lists are updated and
forwarded annually to Permit and Licence Management’. A current membership list must accompany this
application form.
3. Are you between 13 and 18 years of age?
A permit can be granted to a child of 13 years or over. The name and address of the child’s parent or guardian
must be specified in the permit. The parent or guardian must live at the same address as the applicant.
No
Yes
If yes, a parent or legal guardian must complete the following guardian details.
GUARDIAN’S FULL NAME
DATE OF BIRTH
GUARDIAN’S RESIDENTIAL ADDRESS
POSTCODE
TELEPHONE (BUSINESS HOURS)
MOBILE
TELEPHONE (AFTER HOURS)
EMAIL
GUARDIAN’S SIGNATURE
4.
FACSIMILE
DATE
Have you previously held this type of permit?
This may include permits in other States.
Yes
No
If yes, state the permit number (if known)
If yes, and if this permit is for spotter catcher activities has the ‘wildlife data
record’ been submitted?
Yes
No
(A wildlife data record is due for each 3 month period during the life of the permit)
If no, a permit may not be issued until returns are submitted.
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Application form
Rehabilitation permit
5. Place of activity
Please specify the location that is relevant to your application:
a) Rehabilitation permit: This permit can be granted for one place only.
ADDRESS (WRITE “AS ABOVE” IF SAME AS RESIDENTIAL / REGISTERED BUSINESS ADDRESS)
POSTCODE
LOCAL GOVERNMENT AREA
b) Spotter catcher endorsed permit: Please tick whichever is relevant
Statewide
Local
LOCAL GOVERNMENT AREA
6. How do you intend to obtain the animal(s) concerned?
If you already have an animal at the time of making this application, please note that under the Nature
Conservation (Wildlife Management) Regulation 2006, you must either notify a conservation officer and deal
with the animal in the way directed, or give the animal to the holder of a rehabilitation permit for the animal (e.g.
licensed local wildlife care group) within 72 hours of taking possession of the animal.
As an injured animal
As a sick animal
As an orphaned animal
From spotter catcher activities
Other (please give details in the space provided below)
7. Do you have any experience in wildlife care/rehabilitation or spotter catcher
activities?
A rehabilitation permit can only be issued if the applicant is an appropriate person to hold the permit, i.e. if the
applicant has the ability to carry out activities under the permit in a competent and ethical way. For wildlife care
rehabilitation permits if you do not have any experience it is recommended that you contact your local wildlife
care group or experienced rehabilitator for guidance about possible endorsement under their permit.
No
Do not proceed, contact a local wildlife care group/experienced carer for assistance, or
Yes
Please provide the following information:
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Application form
Rehabilitation permit
For a wildlife care rehabilitation permit please supply the following details:
What recognised training courses have you attended and when? (Supply copies of certificates.)
What species did you care for in the past?
Length of experience? (Minimum of 2 years demonstrated experience required)
What facilities/caging do you have available for wildlife rehabilitation?
How do you intend to keep up-to-date with the latest developments in animal husbandry and rehabilitation
techniques?
What support networks do you have?
What conservation benefits will be achieved by issuing this permit?
A rehabilitation permit can only be issued if the applicant has read and understood the requirements of the Code
of Practice – Care of Sick, Injured or Orphaned Protected Animals in Queensland.
No
Do not proceed, please read the Code of Practice before continuing, or
Yes
I have read and understand the Code of Practice.
For a spotter catcher endorsed rehabilitation permit please supply the following details:
Please provide a current resume, including details of qualifications, and provide a statement addressing the
following selection criteria:
Required:

Current first aid certificate

Demonstrated ability to handle a wide variety of wildlife, including macropods and reptiles

Well developed wildlife identification skills

Demonstrated ability to determine appropriate habitat through knowledge of fauna/flora
associations and habitat requirements.
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Application form
Rehabilitation permit
Desirable:

Relevant experience in the fields of zoo-keeping, veterinary practices and/or wildlife
rehabilitation

Access to appropriate equipment to undertake spotter catching activities.
8. What wildlife does the application refer to?
Birds
Mammals
Reptiles
Amphibians
Specific animal/s
Please note, if your application refers to flying-foxes or bats, it is your responsibility to ensure you are
vaccinated against Australian Bat Lyssavirus and that flying-foxes or micro-bats do not come into
contact with unvaccinated family members and friends.
Have you been vaccinated against Australian Bat Lyssavirus?
No
Yes, what date was your last vaccination or titre taken?
Not applicable
9. Referee reports
For new rehabilitation permit applicants and new spotter catcher endorsed rehabilitation permit applicants, give
details and attach written referee reports from two (2) independent people of professional standing to attest to
your competency.
Note: An employee of the Queensland Parks and Wildlife Service (QPWS) or the Department of Environment
and Heritage Protection (EHP) cannot be used as a referee.
Referee 1
Referee 2
Name:
Name:
Current contact details:
Current contact details:
Referee reports are attached
Yes
No
You cannot submit your application until written references are provided
(if applicable).
Note 1: You must provide two referees of professional standing in the relevant wildlife management field e.g.
wildlife care and rehabilitation, fauna surveys, environmental assessments. Suitable referees may be from the
veterinary, zoological or university fields. Referees should be able to attest to your knowledge, skills and
experience as outlined in the responses supplied within this application form. Referees must also outline their
own experience and/or competency, which they believe enables them to attest to your abilities.
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Application form
Rehabilitation permit
Note 2: An experienced rehabilitator is a person with a minimum of five (5) years with ongoing demonstrated
wildlife rehabilitation experience.
Important: Upon expiry of an existing permit, when completing a new application applicants must
answer all questions and supply documentation and referee reports as detailed above in the following
manner:
1. for a rehabilitation permit:
once only, providing a permit is held continuously; for any breaks in licensing of 12 months or more
the applicant must provide current evidence as indicated above in Q.7 and Q 9; and
2. for a spotter catcher endorsed rehabilitation permit:
once only, providing a permit is held continuously; for any breaks in licensing of 12 months or more
the applicant must provide current evidence as indicated above in Q.7 and Q 9.
10. Applicant suitability
The permit may be granted if the applicant is an appropriate person to hold the permit i.e. if the applicant has
the ability to carry out activities under the authority in a competent and ethical way.
QUESTIONS
1. During the past 10 years have you ever (in
Queensland or elsewhere) been found guilty
of any criminal offence or entered a plea of
guilty in a Court?
DETAILS
YES
NO
(Note: does not include simple traffic offences
such as parking, speeding.) If yes, provide
details of the offence/s.
2. Have you ever had an equivalent permit
from another State, Territory or country that
was suspended and/or cancelled?
YES
NO
If yes, provide details about the permit, the
date it was suspended and/or cancelled and
reasons for suspension/cancellation.
11. Privacy statement
Information you provide on this form is being collected by the Department of Environment and Heritage
Protection to process and administer your application for a Collection Authority (Biodiscovery), as authorised
under section 11 of the Biodiscovery Act 2004 (the Act). Some information may be provided to the Department
of Science, Information Technology, Innovation and the Arts for the purpose of the joint regulation of activities
under this Act. Some information may be disclosed to RSPCA Qld or the Queensland Wildlife Rehabilitation
Council for the purpose of receiving information about these organisations and caring for wildlife, if you have
selected these options on this form. Information may also be disclosed to the Departments of National Parks,
Recreation, Sport and Racing; Agriculture, Fisheries and Forestry; or Health in order to investigate allegations of
unlawful activity, biosecurity or health issues, if required. Information regarding your status as a holder of this
type of permit may be provided to any party upon request. Your personal information will not be disclosed to any
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Department of Environment and Heritage Protection
Application form
Rehabilitation permit
other parties unless authorised or required by law. More information on our commitment to privacy is available
on our website: http://www.ehp.qld.gov.au/legal/privacy.html.
12 Declaration
Note: If you have not told the truth in this application you may be liable for prosecution under the relevant Acts
or Regulations.

I do solemnly and sincerely declare that the information provided is true and correct to the best of my
knowledge and I make this solemn declaration conscientiously believing the same to be true.

I understand that all information supplied on or with this application form may be disclosed publicly in
accordance with the Right to Information Act 2009 and the Evidence Act 1977.
APPLICANT’S NAME
APPLICANT’S SIGNATURE
DATE
IF THE APPLICANT IS A CORPORATION, PLEASE INDICATE YOUR POSITION IN THE CORPORATION
Please tick the appropriate box/es if you agree to have your details provided to the following organisations:
I agree to have my name and contact details provided to the Queensland Wildlife Rehabilitation Council (QWRC) for
the purpose of receiving information about QWRC and caring for wildlife.
For more information about QWRC visit: www.qwrc.org.au
I agree to have my name and contact details provided to the RSPCA Qld for the purpose of receiving information
about the RSPCA Qld 1300 ANIMAL Wildlife Hero Network.
For more information about RSPCA Qld visit: www.rspcaqld.org.au
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Department of Environment and Heritage Protection
Application form
Rehabilitation permit
13. Applicant checklist
Application form completed, signed and dated
Current membership list attached
Supporting information attached (if applicable) e.g.
copy of qualifications
history of caring experience
Please return to:
Permit and Licence Management
Department of Environment and Heritage
Protection
GPO Box 2454
Brisbane
Queensland 4001
details of rehabilitation facilities
two referee reports (if applicable).
Privacy statement acknowledged
Enquiries: 1300 130 372
Facsimile: (07) 3330 5875
Email: palm@ehp.qld.gov.au
Code of Practice or guidelines and Information sheet – Wildlife authorities and privacy may be obtained from the
EHP website http://www.ehp.qld.gov.au/licences-permits/plants-animals or by contacting the EHP Referral
Centre on 1300 130 372.
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