Dog for a Day Booking Form

Organisation Name *

Campus (if applicable)

First Name *

Last Name *

Email *

Phone *

Secondary Contact Name *

Secondary Contact Email *

Please choose a dog for a day schedule *

If you choose Multi days please provide details.

Term *

Term 1

Term 2

Term 3

Term 4

If booking for multiple terms please provide details below

What are your school recess and lunch times? *

Day and Time Preference *

Preference 1
Preference 2
Preference 3

What year level will be participating in the program? *

Number of sessions required in the day? *

Where will the sessions be held? Please note the Mentor and Dog will need a location they can work in for the entire day and not be moving from place to place. *

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) *

Please provide any further information or special requirements for your booking. For example if you chose multi days please provide details about the students attending and if they will be the same students each time attending. *

How did you hear about us? *