Youth Program Request Form                      

Today’s Date ___________________

Please print this form and complete the following information.

Return to b j Altschul by fax, 301-279-1998, email bja@mchumane.org , or snail mail:

Montgomery County Humane Society, 14645 Rothgeb Drive, Rockville, MD 20850.

1st choice

Preferred day (circle one) M  T  Th  F and date __________ of visit at least three weeks from today’s date          Preferred time __________

2nd choice

Preferred day (circle one) M  T  Th  F and date __________ of visit at least three weeks from today’s date          Preferred time __________

Please indicate where you would like your group’s presentation to take place:

Main County Animal Shelter, 14645 Rothgeb Dr., Rockville, MD

NEW!  MCHS Private Rescue (includes the Ark Grooming & Pet Supplies Store)

   607 S. Stonestreet Ave., Rockville, MD

Our school or other community location (please fill in address):

_______________________________________________________________________________

_______________________________________________________________________________

Name of group requesting program (Troop #, or School, etc.) ________________________________________________________________________________

# of children in group _____ Age range ______Grade ______# of accompanying adults________

Your name _______________________________________________________________________

Email ___________________________________________________________________________

Phone ____________________________ Cell phone _____________________________________

Street address ____________________________________________________________________

City _____________________________________State _________ Zip ______________________

Please choose one topic from the following list:

What’s involved in caring for a pet, and appropriate pet choices

Managing a community’s pet population and the importance of spay/neuter

Lost & found program including common questions about microchips

Safety around dogs and preventing dog bites

Holiday/seasonal safety tips

Pet travel safety tips

Pet nutrition

NEW! Grooming demo at the Ark (can be done only when visiting the MCHS Private Rescue)

based on availability

Triumph story (talk about and/or meet special needs animals that overcame the odds) based on

availability

Pros and cons of keeping exotics (wild animals) as pets

Please choose one activity from the following list:

Practicing empathy activities

NEW! Read me a story! (Recommended for pre-K thru 2nd grade – read-aloud stories about

shelter and rescue animals, with focus on character development, meets Maryland Department

of Education State Standards requirements)

Learning to understand animal behavior

Drawing cage signs

Pop quiz on animal welfare, with prizes

Equipment demo by an Animal Services Division officer & look at a rescue car – based on

availability, main County Animal Shelter only

Learning the parts of a dog

Puppy needs board game