* There are 2 steps to request a visit. 1. First, complete the KPETS Terms and Conditions for Services form. and submit it to requests@kpets.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 Elderly Children Teens At-risk Teens Special needs Rehab Therapy (PT, OT, ST or Cognitive) Individual to be visitedIndividual to Visit* IndToVisitFirst IndToVisitLast Facility Type* Education (school, library, college) Family/Community Services (camps, support groups) Healthcare (Hospital, rehab, skilled nursing Hospice Justice System Justice System (correction center, courthouse, police STATION setting)) Residential (senior housing, group home First Responders (EMS, Fire, Police) Other 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 DetailsAbout Your Request...AddressPlease tell us where this request will be fulfilled Street Address Address Line 2 City State Zip Code County - not CountRy. 🙂 Type of Visit* One Time Monthly Specific Dates/Times Gender of person(s) to be seen Male Female Both Preferred Pet Type Dog Cat Miniature Equine Other 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 : Hours Minutes AM PM AM/PM End Time : Hours Minutes AM PM AM/PM Approx number of attendees*Contact Information...ContactName ContactFirstName ContactLastName 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 requests@kpets.org or mail to
KPETS, 1001 E Oregon Rd, Lititz PA 17543.
