Please complete the form below to help us understand your needs and how Dominique can best serve your organization.

Full Name

Organization / Facility

Phone *

Email *

There is no charge for Dominique's visits, but donations for his care, upkeep, and vehicle maintenance are gratefully accepted. Click here to donate to Dominique's Smiles.

Location of Visit Address

State *

City *

Postal Code

Type of Organization *

Please describe your organization, who you serve, and how Dominique’s visit could best support your group.

What kind of visit do you need? *

Therapy Horse

Educator/Speaker

Not Sure

Estimated Attendance

Children (approximate ages)

Adults

By checking this box, I consent to receive marketing and promotional messages and information updates, among others. from Dominique's Smiles at the email address provided.