Spring Session 2 Registration - HousePaws Mobile Veterinary Service

Student Details

* Required Fields

Student's Name*

Student's Name: *

First Last

Date of Birth*

Date of Birth: *

Age*

Age: *

Gender*

Gender: *

Male
Female

Health Concerns*

Does your child have any health or concerns we should be aware of? *
(i.e. asthma, allergies (food or animal),hearing or vision difficulties, special needs etc.?)

Yes
No

Please Explain*

Please Explain: *

Classes

Which class(es) would you like to register for?*

Pre-K & Kindergarten: Pre-Vet Techs
Grades 1-3: Little Vet Techs
Grades 4-6: Ready Vet Go
Grades 7-8: The Interns & Grades 9-12: The Residents
Home school All Ages Class (Sibling Discounts)
Home School Special with added ½ hour - 6-12th grade (Added Time in Hospital)

Class 1

Pre-Kindergarten and Kindergarten: Pre-Vet Techs

Thursdays, 4-5pm - $80
Saturdays, 11:15am-12:15pm - $100
None

Class 2

Grades 1-3: Little Vet Techs

Tuesdays, 10:30 am -11:30 pm - $80
Tuesdays, 5:30pm-6:30pm - $80
Fridays, 5:30 pm-6:30 pm - $80
Saturdays, 11:15am-12:15pm $100
None

Class 3

Grades 4-6: Ready Vet Go

Tuesdays, 10:30am-11:30pm $80
Wednesdays, 4:00 pm- 5:00 pm - $80
Wednesdays, 5:30 pm- 6:30 pm - $80
Thursdays, 10:30 am- 11:30 am - $80
None

Class 4

Grades 7-8: The Interns & Grades 9-12: The Residents

Mondays, 5:30pm-6:30pm $80
Thursdays, 5:30 pm- 6:30 pm - $80
Fridays, 11:30 am -1:00 pm - $100
None

Class 5

Home school All Ages Class (Sibling Discounts)

Wednesdays, 10am-11am $80
Wednesdays, 1:00-2:30 pm - $100
None

Class 6

Home School Special with added ½ hour - 6-12th grade (Added Time in Hospital)

Tuesdays, 12-1:30 pm - $125
None

Click To Add/Remove Another Student (1)

Click To Add/Remove Another Student (5% Discount)

Second Student Details (5% Discount)

* Required Fields

Student's Name (Second Student)*

Student's Name: *

First Last

Date of Birth (Second Student)*

Date of Birth: *

Age (Second Student)*

Age: *

Gender (Second Student)*

Gender: *

Male
Female

Health Concerns (Second Student)*

Does your child have any health or concerns we should be aware of? *
(i.e. asthma, allergies (food or animal),hearing or vision difficulties, special needs etc.?)

Yes
No

Please Explain (Second Student)*

Please Explain: *

Classes

Class 1 (Second Student)

Pre-Kindergarten and Kindergarten: Pre-Vet Techs

Thursdays, 4pm-5pm $76
Saturdays, 11:15am-12:15pm $95
None

Class 2 (Second Student)

Grades 1-3: Little Vet Techs

Tuesdays, 10:30 am -11:30 pm $76
Tuesdays, 5:30pm-6:30pm - $76
Fridays, 5:30 pm-6:30 pm - $76
Saturdays, 11:15am-12:15pm $100
None

Class 3 (Second Student)

Grades 4-6: Ready Vet Go

Tuesdays, 10:30am-11:30am $76
Wednesdays, 4:00 pm- 5:00 pm - $76
Wednesdays, 5:30 pm- 6:30 pm - $76
Thursdays, 10:30 am- 11:30 am - $76
None

Class 4 (Second Student)

Grades 7-8: The Interns & Grades 9-12: The Residents

Mondays, 5:30pm-6:30pm $76
Thursdays, 5:30 pm- 6:30 pm - $76
Fridays, 11:30 am -1:00 pm - $95
None

Class 5 (Second Student)

Home school All Ages Class (Sibling Discounts)

Wednesdays, 10-11am $76
Wednesdays, 1:00-2:30 pm - $95.00
None

Class 6 (Second Student)

Home School Special with added ½ hour - 6-12th grade (Added Time in Hospital)

Tuesdays, 12:00-1:30 pm - $118.75
None

Click To Add/Remove Another Student (2)

Click To Add/Remove Another Student (10% Discount)

Third Student Details (10% Discount)

* Required Fields

Student's Name (Third Student)*

Student's Name: *

First Last

Date of Birth (Third Student)*

Date of Birth: *

Age (Third Student)*

Age: *

Gender (Third Student)*

Gender: *

Male
Female

Health Concerns (Third Student)*

Does your child have any health or concerns we should be aware of? *
(i.e. asthma, allergies (food or animal),hearing or vision difficulties, special needs etc.?)

Yes
No

Please Explain (Third Student)*

Please Explain: *

Classes

Class 1 (Third Student)

Pre-Kindergarten and Kindergarten: Pre-Vet Techs

Thursdays, 4pm-5pm $72
Saturdays, 11:15AM-12:15PM $90
None

Class 2 (Third Student)

Grades 1-3: Little Vet Techs

Tuesdays, 10:30 am -11:30 am $72
Tuesdays, 5:30pm-6:30pm - $72
Fridays, 5:30 pm-6:30 pm $72
Saturdays, 11:15am-12:15pm $90
None

Class 3 (Third Student)

Grades 4-6: Ready Vet Go

Tuesdays, 10:30am-11:30am $72
Wednesdays, 4:00 pm- 5:00 pm $72
Wednesdays, 5:30 pm- 6:30 pm - $72
Thursdays, 10:30 am- 11:30 am $72
None

Class 4 (Third Student)

Grades 7-8: The Interns & Grades 9-12: The Residents

Mondays, 5:30-6:30pm $72
Thursdays, 5:30 pm- 6:30 pm $72
Fridays, 11:30 am -1:00 pm - $90
None

Class 5 (Third Student)

Home school All Ages Class (Sibling Discounts)

Wednesdays, 10-11am $72
Wednesdays, 1:00-2:30 pm - $90.00
None

Class 6 (Third Student)

Home School Special with added ½ hour - 6-12th grade (Added Time in Hospital)

Tuesdays, 12:00pm - 1:30pm $112.50
None

Marketing Photo Release Consent

We want your Vet in Training to be Facebook famous, but we need your permission first. Please review the terms and select the consent option below.

I grant permission to HousePaws Mobile Veterinary Service and HousePaws Vets in Training Program, its employees and authorized representatives to take photographs and/or video of me and/or my son/daughter, to copyright, use and publish the same in print and/or electronically. HousePaws may also use and publish my pet’s story, including relevant medical history.

I agree that HousePaws may use such photographs, videos or stories including me and/or my son/daughter with or without our names and for any lawful purpose, including for example such purposes as social media, publicity, advertising, and other Web content.

Check One*

Check One: *

Yes. I consent.
No. I do not consent.

Vet in Training Student(s) Name(s)*

Vet in Training Student(s) Name(s): *

Parent Name*

Parent Name: *

Registration Information

Parent/Guardian 1 Information

Parent/Guardian 1 Information: *

First Last

Parent/Guardian 1 Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1 Email*

Parent/Guardian 1 Phone*

Parent/Guardian 1 Alternate Phone

Parent/Guardian 2 Information

Parent/Guardian 2 Information:

First Last

Parent/Guardian 2 Address

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Parent/Guardian 2 Alternate Phone

Health Information

Other Emergency Contact*

Other Emergency Contact: *

Emergency Contact Phone Number*

Emergency Contact Phone Number: *

Emergency Contact Relationship to Child*

Emergency Contact Relationship to Child: *

Payment Information

Payment choice*

Please indicate your choice of payment. Registration is not complete unless payment made in full. Contact VITregistrations@housepawsmobilevet.com if you wish to pay by check.

Pay by credit card below
Mail or bring payment by check to VIT Center

Total For All Selected Classes

Total For All Selected Classes:

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VIT Fall 2019 Session 1

Student Details

Classes

Second Student Details (5% Discount)

Classes

Third Student Details (10% Discount)

Classes

Marketing Photo Release Consent

Registration Information

Health Information

Payment Information

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