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« All Events
November 12, 2022 Evaluations at Providence Medical Center
November 12 @ 8:00 am
-
5:00 pm
$10
Event Navigation
«
October 15, 2022 Evaluations at Providence Medical Center
December 10, 2022 Evaluations at Providence Medical Center
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Details
Date:
November 12
Time:
8:00 am - 5:00 pm
Cost:
$10
Contact
Name
*
Email
*
Primary Phone
*
Secondary Phone:
*
Name of Organization:
What are you interested in?
*
Please Select:
Becoming a Therapy Team
Hosting a Special Event
General Inquiry
Are you interested in:
*
Please Select:
A Special Event (a single event or an event occurring once or twice per year)
A Therapy Animal Visiting Program (a visiting program that occurs on a regular schedule(weekly, monthly, quarterly)
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?
Rats
Cats
Mini Horses
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.):
Comment/Message:
Comment/Message:
Type of Facility:
*
Healthcare (eg; hospital, rehab/skilled nursing, hospice)
Education (eg; school, library)
Residential (eg; group home, senior living)
Justice System
Other
Age of Clients (check all that apply):
*
Children
Adults
Seniors
Staff Involvement:
*
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)
Client Participation (check all that apply):
Individual (eg; one on one)
Small group (eg; less than 5)
Medium group (eg; 5-15)
Large group (eg; more than 15)
Species Welcomed:
Dog
Cat
Horse
Rat
Guinea Pig
Questions or Comments?
Email
This field is for validation purposes and should be left unchanged.
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