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Upcoming Events › Evaluations › – Mo-Kan Pet Partners
Upcoming Events › Evaluations › – Mo-Kan Pet Partners
Mo-Kan Pet Partners
A Community Division of Pet Partners
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Name
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Secondary Phone:
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What are you interested in?
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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?
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:
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Select One
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:
Individual (eg; one on one)
Small group (eg; less than 5)
Medium group (eg; 5-15)
Large group (eg; more than 15)
Comments
This field is for validation purposes and should be left unchanged.
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