Chien de Thérapie en Visite

Connaissez-vous un groupe qui aimerait rencontrer un ou plusieurs de nos merveilleux chiens de thérapie en visite certifiés Companion Paws?

Le programme propose des visites thérapeutiques à ceux qui ont besoin des soins et du confort de nos compagnons de thérapie formés et certifiés.

Veuillez remplir le formulaire de demande de visite ci-dessous et nous vous indiquerons la disponibilité des équipes de visiteurs.

Name of Facility *

Street Address *

City *

Province *

Postal Code *

Facility Website

Facility Type *

Education (ex: school, college, library)

Family/Community Services (ex: camps, support groups)

Healthcare (ex: hospital, rehab, skilled nursing)

Hospice

Justice System (ex: correction center, courthouse, police station)

Residential (ex: senior housing, group home)

Special Event (ex: mental health awareness, de-stressing event)

Other

Dates and Times of Visiting Request(s) *

Visit or Event Type and Details *

Age of Persons Receiving Visits *

Children

Adults

Seniors

Check All That Apply

Level of Staff Involvement During Visits by Therapy Dog Teams *

Active (high activity, many distractions, routinely unanticipated interactions, volatile setting)

Moderate (some activity and distractions, occasionally unanticipated interactions)

Quiet (low activity, routine interactions, predictable setting)

Check All That Apply

Clients Participating per Interaction *

Individual

Small Group (less than 5)

Medium Group (5-15)

Large Group (more than 15)

Check All That Apply

Is this a one-time or recurring volunteer opportunity? *

Details/Description *

Please deescrive your opportunity for prospective volunteers visiting teams. This would include information about your facility, special event, the persons in attendance and any special requests.

Contact Name *

Who is the Contact for our Volunteers?

Contact Title *

Contact Phone *

Contact Email *