Name* Mr.Mrs.MissMs.Dr.Prof.Rev.Mx.None Prefix First Last Program or Venue Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Cell PhonePreferred form of contact.* Phone Email Birthdate MM slash DD slash YYYY How did you hear about CHS?CHS SupporterCHS VolunteerCHS EventFriendsEmployerSocial NetworkDirect MailingsEmailsPrint AdvertisementsRadioFlyersOtherIf other, please enter how you heard about CHS.0 of 75 max charactersName of Group*0 of 50 max charactersAge of Group Members*0 of 30 max charactersNumber of People in Group*0 of 30 max charactersWhat type of program would you like?*Paws and PagesPet Care 101PaCK: Pets and Caring KidsSafety PAWtrol: Dog Safety and Bite PreventionPet ProfessionsBeyond the Breed: Exploring Dog DNAPet Boredom BustersAll About CHSKind KidsPAWsome ResumesPreferred date of youth program.*0 of 50 max charactersPreferred time of youth program.*0 of 50 max charactersLength of program.* 30 minutes 45 minutes 60 minutes How would you like your program presented?* Virtually In-person Program Fee*Paws and Pages has a $50 fee per class of 35 students. All other programs are $80 per class of 35 or $200 per assembly up to 150 students. Limited scholarship funds are available. If you are experiencing a hardship that would prevent your group from participating, please select “scholarship” to be considered.CashCheckCredit cardScholarshipCAPTCHA
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