Fish Tank Therapy Aquarium Application
*Please read aquarium agreement prior to filling our this form. Please fill out this form to the best of your ability.
Email address *
Full Name *
Your answer
Caregiver or Guardian if under 18 or applying for someone other than yourself.
Your answer
Address *
Your answer
Age
Your answer
Phone Number *
Your answer
How long have you been at your residence? *
Your answer
Why do you want an aquarium?
Your answer
Is this your first aquarium? *
What has your previous experience been like with aquariums?
Your answer
Why do you currently not have an aquarium?
Your answer
How would this aquarium be therapeutic to you? *
Your answer
Will you be able to maintain the aquarium and provide daily feedings and routine maintenance? *
If chosen, what type of aquarium would you be interested in? *
Your answer
We give priority to individuals who are Autistic or Suffer from PTSD. Does either apply to you?
Do you have any medical conditions that may benefit from aquatic therapy?
Your answer
Thank You! We will be in touch soon!
We unfortunately cannot give an aquarium to all that apply. Our goal is to donate to as many individuals as possible. We will be in contact with you within 4-6 weeks to notify if you were chosen or not. Please do not email regarding your status, this will NOT SPEED UP THE PROCESS. All chosen applicants will be chosen by a council and this is not a sole decision of anyone within Fish Tank Therapy. Please contact us at fishtanktherapy@gmail.com if you have any questions or concerns. Thank you! We appreciate your support!
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