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.Name of Group*Age of Group Members*Number of People in Group*What 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.*Preferred time of youth program.*Length 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
