ADNW Therapy Dog Request Form
General Information
Group/Company Name
Address Line 1
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City
State
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Alabama
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District Of Columbia
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Northern Mariana Islands
Guam
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Postal Code
Contact Person
Title
Email
Phone Number
Visit Information
Requested Date(s) and Time(s)
Size of Group
Average Age
Please briefly describe your goals for the ADNW Therapy Dog Visit(s) and how much time you would like the dogs to be present:
Are you also looking to have a presentation about Assistance Dogs integrated into the visit as well?
Yes
No, not at this time.
If you checked “Yes” to the question above, please check all that apply:
Ability to connect a laptop to a TV or projector.
Have a screen or projector.
DVD player with TV.
Contact Information