Organisation Name *

Campus (if applicable)

First Name *

Last Name *

Email *

Phone *

Secondary Contact Name *

Secondary Contact Email *

Date of Event *

If multiple dates, please add the dates here

Total length of the Event? How long will you need a Facilitator and dog for?

Time of event

Type of Event

If you selected Other please provide details here

Where will the event be held? For example outside, in the library, in a theatre etc. *

Who will be responsible for funding the program? *

Is there parking available? If not where will the tutor park? (Please keep in mind our tutors carry equipment and have a dog) *

How did you hear about us? *