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February 2, 2019 @ 8:30 am
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February 2, 2019
8:30 am - 5:00 pm
Providence Medical Center
8929 Parallel Parkway
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What are you interested in?
Becoming a Therapy Animal Team
Therapy Animal Visits at My Organization
Name of Organization:
Name of Your Event:
Description of Your Event:
Day(s) of the Week, Date, and Beginning/End Time of Your Event:
What species would you like to have participate in your event?
Dogs (they will need a grassy area to relieve themselves- handlers will dispose of waste.)
Approximately how many people will be attending your event?
Total number of teams you would like for your event:
Address and name of building for your event:
What is the approximate size of the space where the animal teams will be visiting with the clients/patients/residents?
Day of contact person and phone number:
Parking Information (will parking be provided, where should teams park, will they need parking passes, etc.):
Type of Facility:
Healthcare (eg; hospital, rehab/skilled nursing, hospice)
Education (eg; school, library)
Residential (eg; group home, senior living)
Age of Clients (check all that apply):
High (eg; accompany, supervise)
Low (eg; provide a visit list)
Activity Level of Facility:
Active (eg; many distractions, routinely unanticipated interactions, potentially volatile)
Moderate (eg; some distractions, occasional unanticipated interaction)
Quiet (eg; routine interactions, predictable setting)
Individual (eg; one on one)
Small group (eg; less than 5)
Medium group (eg; 5-15)
Large group (eg; more than 15)
This field is for validation purposes and should be left unchanged.