One Time Event Request Form

Event Contact Information

Facility Name *

First Name *

Last Name *

Position/Title (please note: this form must be filled out by a staff/faculty member) *

Email *

Phone Number *

What is the address for the visit? *

Will you be the contact person for our volunteers on the day of your event? *

Yes

If you will not be the contact person for our volunteers on the day of your event, please provide the name and phone number of the person who will be available should our volunteers need assistance.

First Name *

Last Name *

Email *

Phone Number *

Event Details

Have we ever visited your facility before? *

Yes

Have you confirmed that your facility allows animals on premises? *

Yes

Sometimes dogs are not allowed in certain buldings or areas. If you have not received specific permission for a therapy dog visit from a building or site manager, we ask that you do so before completing this form.

Please provide the day and time of your event. If you have not yet scheduled the exact day and time, please provide as much information as possible in the text box below. Please note: same month events are not possible - e.g. for an event in May, we need the info by April.

Day of Event +

Start Time (HH:MM AM/PM)

End Time (HH:MM AM/PM)

Please provide a short blurb about your event (activities, population being served, number of people expected, why dog therapy at this particular event, etc). A portion of this may appear in our monthly newsletter to potential teams. *

What is the ideal number of therapy dogs you would like for your event? Please note that each dog can only stay up to one hour.
*

Please provide directions for our volunteers to follow when they arrive on site the day of your event. *

What is the parking situation going to be like at your event (i.e street parking, parking lot, metered parking)? Please include any fees. *