Experience Connections Package Booking Form

Each week, a therapy dog and mentor visit your school for a full day, supporting two groups of students through your choice of programs and completing the rest of the day with the Dog for half a day of fun.

Organisation Name *

Campus (if applicable)

First Name *

Last Name *

Email *

Phone *

Secondary Contact Name *

Secondary Contact Email *

Term

Term 1

Term 2

Term 3

Term 4

What are your school recess and lunch times? *

Day and Time Preference

Preference 1
Preference 2
Preference 3

Program choice 1 *

Program Choice 2

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) *

Is there anything else we need to know? *

Have you booked a chat with Sarah or Louise to discuss the package. Once you have submitted this form you can book a chat at a later date. *

Yes

No

Previous Client - Don't need to

How did you hear about us? *