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 InformationName* First Last Phone*Email Relationship to the child/youth*Example: DHS Caseworker, CASA, Attorney, etc. Child InformationName* First Name Enter the first name of the child or youth who will benefit from the services of a court therapy dogAge123456789101112131415161718192021older than 21Select the age of the child/youthGenderMaleFemalePrefer Not to AnswerEnter the gender of the child/youthScheduling InformationDate* Date Format: MM slash DD slash YYYY Select the date services are neededTime* : HH MM AM PM Enter the anticipated time services are neededEstimated 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 NumberEnter 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 Please Share This Tweet Share Plus one