* There are 2 steps to request a visit. 1. First, complete the KPETS Terms and Conditions for Services form. and submit it to firstname.lastname@example.org or mail to KPETS, 1001 E Oregon Rd, Lititz PA 17543.2. Second, you must complete and submit the online form below.
My KPETS Terms and Conditions for Services Form has been signed and completed. It was submitted via:*NOTE: this is a new from due to Covid19. All previous forms on file must be replaced with this new form.
I emailed the form
I sent the form via Postal Service
Use dropdown to select Type of Service Requested*Visit an IndividualVisit a Facility or GroupPresentationEventName of Group, Facility, or Event* Type of Audience
Rehab Therapy (PT, OT, ST or Cognitive)
Individual to be visitedIndividual to Visit*
Education (school, library, college)
Family/Community Services (camps, support groups)
Healthcare (Hospital, rehab, skilled nursing
Justice System (correction center, courthouse, police STATION setting))
Residential (senior housing, group home
First Responders (EMS, Fire, Police)
Approx Number of attendees*
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 DetailsAbout Your Request...AddressPlease tell us where this request will be fulfilled
Address Line 2
County - not CountRy. 🙂 Type of Visit*
Gender of person(s) to be seen
Preferred Pet Type
Additional DetailsPlease include COVID related guidelines and expectations for our volunteers to safely visit.Date InformationWe prefer three weeks advance notice, but feel free to submit your request and we will do our best to fill your need.Preferred Date
MM slash DD slash YYYY
Start Time of event or visit
Approx number of attendees*Contact Information...ContactName
Contact Title ContactPhoneContact Email*
Donor / Sponsor Opportunities
Please send me information on KPETS Donor and Sponsor Opportunities
Approvals & Legal InformationTo 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.
and submit it to email@example.com or mail to
KPETS, 1001 E Oregon Rd, Lititz PA 17543.