{"id":4421,"date":"2018-12-31T14:19:22","date_gmt":"2018-12-31T22:19:22","guid":{"rendered":"https:\/\/thelifelinecanada.ca\/?page_id=4421"},"modified":"2019-04-05T14:05:16","modified_gmt":"2019-04-05T21:05:16","slug":"visiting-therapy-dog-request-form","status":"publish","type":"page","link":"https:\/\/companionpaws.ca\/fr\/visiting-therapy-dog-request-form\/","title":{"rendered":"Chien de Th\u00e9rapie en Visite"},"content":{"rendered":"<h3><strong><span class=\"menu-text\">Chien de Th\u00e9rapie en Visite<\/span><\/strong><\/h3>\n<p>Connaissez-vous un groupe qui aimerait rencontrer un ou plusieurs de nos merveilleux chiens de th\u00e9rapie en visite certifi\u00e9s Companion Paws?<\/p>\n<p>Le programme propose des visites th\u00e9rapeutiques \u00e0 ceux qui ont besoin des soins et du confort de nos compagnons de th\u00e9rapie form\u00e9s et certifi\u00e9s.<\/p>\n<p>Veuillez remplir le formulaire de demande de visite ci-dessous et nous vous indiquerons la disponibilit\u00e9 des \u00e9quipes de visiteurs.<\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-6\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-6\" value=\"1775379056\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"6\" id=\"\"><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField161\"><div class=\"vfb-form-group\"><label for=\"vfb-field-161\" class=\"vfb-control-label\">Name of Facility <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-161\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-161\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField162\"><div class=\"vfb-form-group\"><label for=\"vfb-field-162\" class=\"vfb-control-label\">Street Address <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-162\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-162\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField163\"><div class=\"vfb-form-group\"><label for=\"vfb-field-163\" class=\"vfb-control-label\">City <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-163\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-163\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField164\"><div class=\"vfb-form-group\"><label for=\"vfb-field-164\" class=\"vfb-control-label\">Province <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-164\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-164\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField165\"><div class=\"vfb-form-group\"><label for=\"vfb-field-165\" class=\"vfb-control-label\">Postal Code <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-165\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-165\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField166\"><div class=\"vfb-form-group\"><label for=\"vfb-field-166\" class=\"vfb-control-label\">Facility Website<\/label><div><input id=\"vfb-field-166\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-166\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField167\"><label for=\"vfb-field-167\" class=\"vfb-control-label\">Facility Type <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" required=\"required\" type=\"checkbox\" name=\"vfb-field-167[0]\" value=\"1\">Education (ex: school, college, library)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[1]\" value=\"1\">Family\/Community Services (ex: camps, support groups)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[2]\" value=\"1\">Healthcare (ex: hospital, rehab, skilled nursing)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[3]\" value=\"1\">Hospice<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[4]\" value=\"1\">Justice System (ex: correction center, courthouse, police station)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[5]\" value=\"1\">Residential (ex: senior housing, group home)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[6]\" value=\"1\">Special Event (ex: mental health awareness, de-stressing event)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-167-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-167\" type=\"checkbox\" name=\"vfb-field-167[7]\" value=\"1\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField168\"><div class=\"vfb-form-group\"><label for=\"vfb-field-168\" class=\"vfb-control-label\">Dates and Times of Visiting Request(s) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-168\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-168\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField169\"><div class=\"vfb-form-group\"><label for=\"vfb-field-169\" class=\"vfb-control-label\">Visit or Event Type and Details <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-169\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-169\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField170\"><label for=\"vfb-field-170\" class=\"vfb-control-label\">Age of Persons Receiving Visits <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-170-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-170\" required=\"required\" type=\"checkbox\" name=\"vfb-field-170[0]\" value=\"1\">Children<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-170-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-170\" type=\"checkbox\" name=\"vfb-field-170[1]\" value=\"1\">Adults<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-170-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-170\" type=\"checkbox\" name=\"vfb-field-170[2]\" value=\"1\">Seniors<\/label><\/div><span class=\"vfb-help-block\">Check All That Apply<\/span><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField171\"><label for=\"vfb-field-171\" class=\"vfb-control-label\">Level of Staff Involvement During Visits by Therapy Dog Teams <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-171-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-171\" required=\"required\" type=\"checkbox\" name=\"vfb-field-171[0]\" value=\"1\">Active (high activity, many distractions, routinely unanticipated interactions, volatile setting)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-171-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-171\" type=\"checkbox\" name=\"vfb-field-171[1]\" value=\"1\">Moderate (some activity and distractions, occasionally unanticipated interactions)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-171-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-171\" type=\"checkbox\" name=\"vfb-field-171[2]\" value=\"1\">Quiet (low activity, routine interactions, predictable setting)<\/label><\/div><span class=\"vfb-help-block\">Check All That Apply<\/span><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField172\"><label for=\"vfb-field-172\" class=\"vfb-control-label\">Clients Participating per Interaction <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-172-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-172\" required=\"required\" type=\"checkbox\" name=\"vfb-field-172[0]\" value=\"1\">Individual<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-172-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-172\" type=\"checkbox\" name=\"vfb-field-172[1]\" value=\"1\">Small Group (less than 5)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-172-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-172\" type=\"checkbox\" name=\"vfb-field-172[2]\" value=\"1\">Medium Group (5-15)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-172-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-172\" type=\"checkbox\" name=\"vfb-field-172[3]\" value=\"1\">Large Group (more than 15)<\/label><\/div><span class=\"vfb-help-block\">Check All That Apply<\/span><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField173\"><div class=\"vfb-form-group\"><label for=\"vfb-field-173\" class=\"vfb-control-label\">Is this a one-time or recurring volunteer opportunity? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-173\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-173\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField174\"><div class=\"vfb-form-group\"><label for=\"vfb-field-174\" class=\"vfb-control-label\">Details\/Description <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-174\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-174\" value=\"\"><span class=\"vfb-help-block\">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.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField175\"><div class=\"vfb-form-group\"><label for=\"vfb-field-175\" class=\"vfb-control-label\">Contact Name <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-175\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-175\" value=\"\"><span class=\"vfb-help-block\">Who is the Contact for our Volunteers?<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField176\"><div class=\"vfb-form-group\"><label for=\"vfb-field-176\" class=\"vfb-control-label\">Contact Title <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-176\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-176\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField177\"><div class=\"vfb-form-group\"><label for=\"vfb-field-177\" class=\"vfb-control-label\">Contact Phone <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-177\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-177\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField178\"><div class=\"vfb-form-group\"><label for=\"vfb-field-178\" class=\"vfb-control-label\">Contact Email <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-178\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-178\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField179\"><button id=\"vfb-field-179\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>Chien de Th\u00e9rapie en Visite Connaissez-vous un groupe qui aimerait [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"_links":{"self":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4421"}],"collection":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/comments?post=4421"}],"version-history":[{"count":7,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4421\/revisions"}],"predecessor-version":[{"id":4954,"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/pages\/4421\/revisions\/4954"}],"wp:attachment":[{"href":"https:\/\/companionpaws.ca\/fr\/wp-json\/wp\/v2\/media?parent=4421"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}