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Humane Education Interest Form
Name
Email address
Phone number
Organization name
Organization address
Grade level
Age range
Number of participants
Areas of interest
Pets Basic Needs
3rd-6th grade
How Animals Perceive the World
3rd-6th grade
Animal Behavior and Communication
3rd-12th grade
What is Animal Cruelty?
5th-12th grade
Animal Sheltering
5th-12th grade
Why Spay/Neuter?
5th-12th grade
Bully Breed Discrimination
6th-12th grade
Careers in Animal Welfare
6th-12th grade
Other
Enter other…
Requested date and time of presentation
Requested date and time of presentation : Date
Requested date and time of presentation : Time
Type of visit
Off-site presentation
On-site shelter visit
For off-site presentations, are animal visitors permitted?
Yes
No
For off-site presentations, can we bring a flash-drive and plug into your technology?
Yes
No
For off-site presentations, please describe available parking.
Are you interested in an ongoing partnership?
How did you hear about our program?
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