Request Our Services

Use dropdown to select Type of Service Requested*

Due to high demand for service we are typically not available to attend events such as mini-thons, rallies, fun days, or carnivals, etc.

Name of Group, Facility, or Event*

Type of Audience

Elderly
Children
Teens
At-risk Teens
Special needs
Rehab Therapy (PT, OT, ST or Cognitive)
Hospital Patients
Hospice Patients

Individual to be visited

Individual to Visit*

IndToVisitFirst IndToVisitLast

Facility Type*

Approx Number of attendees*

Individual
Small group (less than 5)
Medium group (between 5-15
Large group (more than 15)

Activity Level of those where visits occur

Active (high activity, many distractions, volatile setting, routinely unanticipated interactions)
Moderate (some activity and distractions, some unanticipated interactions)
Quiet (low activity, predictabel setting)

About Your Group, Facility or Event...

Address and Details

Address

Please tell us where this request will be fulfilled

Street Address Address Line 2 City State Zip Code

County - not CountRy. 🙂

Describe the parking arrangements for KPETS volunteers. (Free parking options must be available.)

Check the option which best describes your facility or business*

Non-Profit
Private
Public

About Your Request...

Type of Visit*

One Time
Monthly
Specific Dates/Times

Preferred Pet Type

Dog
Cat

Additional Details

Please include COVID related guidelines and expectations for our volunteers to safely visit.

Date Information

We prefer three weeks advance notice, but feel free to submit your request and we will do our best to fill your need.

Preferred Date

Start Time of event or visit

:

End Time

:

Approx number of attendees*

Contact Information...

ContactName

First Name Last Name

Contact Title

Contact Phone

Contact Email*

Secondary Contact Name

First Name Last Name

Secondary Contact Title

Secondary Contact Phone

Secondary Contact Email*

Facility Owner, President, or Director Name

First Name Last Name

Facility Owner, President, or Director Title

Facility Owner, President, or Director Phone

Facility Owner, President, or Director Email

Donor / Sponsor Opportunities

As a non-profit, KPETS does not charge for our service, but donations and fund-raising efforts are very much needed to sustain and grow our services. We ask that whenever possible our visit locations include us in their annual program budget or giving plan, in employee matching fund programs, and other financial gift programs during holidays and special occasions.

Approvals & Legal Information

To fulfill your requests as quickly as possible, please approve the following items:

I approve KPETS to post my request on the KPETS Konnections Blog
I approve my name, email, and phone number to be posted on the KPETS Konnections Blog.
I understand that KPETS will not be held liable for the connections made.
I have signed and returned the recipient release form.

Touching Lives, Warming Hearts

Through Human/Animal Interactions

Notice Regarding Form Submissions

Individual to be visited

About Your Group, Facility or Event...

About Your Request...

Date Information

Contact Information...

Donor / Sponsor Opportunities