Request a therapy dog

Name *

First Name

Last Name

Phone *

Please leave a mobile number that we will be able to contact

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

For what reasons would you like a therapy dog?

Reading dog

To support emotional wellbeing

Workshop to explore empathy or bullying

Other (please detail below)

How many pupils will your therapy dog encounter?

Whole class (workshops)

Smaller groups (time away from the classroom or readiing sessions)

One pupils at a time (1-2-1 sessions)

How frequently would you like visits from a therapy dog?

Weekly

Fortnightly

Monthly

Once a term

Please tick to confirm you are happy to donate an annual admin fee of £99 (note all therapy dog volunteer sessions thereafter are free)

Yes that's fine