Request a Therapy Dog - CASA of Lane County

If you would like to request a Therapy Dog for a child, youth or individual in need, please fill out the form below and we will contact you shortly.

Or you can call Marina Mlynczyk, FETCH/ATD Court Therapy Dog Coordinator, at (541) 513-3995.

Requesting Party Information
Name*
First Last
Phone*
Email
Relationship to the child/youth*

Example: DHS Caseworker, CASA, Attorney, etc.
Child Information
Name*
First Name
Enter the first name of the child or youth who will benefit from the services of a court therapy dog
Age
Select the age of the child/youth
Gender
Enter the gender of the child/youth
Scheduling Information
Date*
MM slash DD slash YYYY

Select the date services are needed
Time*

: Hours

Minutes

AM/PM

Enter the anticipated time services are needed
Estimated length/duration of need*

Please enter how long you think services will be needed for (Example: 30 minutes, 2 hours, until 1 PM, etc.)
Case Number

Enter the case number (if available)
Brief description of need*
Please enter a brief explanation about why you are requesting the services of a court therapy dog.
I AM REQUESTING THE SERVICES OF A FETCH THERAPY DOG TEAM.

Lane County Juvenile Court and CASA of Lane County have established a partnership with FETCH to benefit children and youth who have cases that come before the Lane County Juvenile Court.

All volunteers with FETCH/ATD have passed a CASA of Lane County background check and agreed to maintain confidentiality when providing services to children youth and families in Lane County.
*
- I have read the above statement and am requesting the services of a FETCH/ATD court therapy dog team

Requesting Party Information