Touching Lives, Warming Hearts
Through Human & Animal Interactions
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Request our Services_
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Request Our Services
Request Our Services
* 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 Individual
Visit a Facility or Group
Presentation
Event
Name 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 visited
Individual 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 Details
About Your Request...
Address
Please 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 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
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
ContactPhone
Contact Email
*
Donor / Sponsor Opportunities
Please send me information on KPETS Donor and Sponsor Opportunities
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.
