Please keep a copy for your reference.

Delta Society Handler Workshop PLEASE INDICATE WHICH DATE YOU ARE SIGNING UP FOR!
Evening Class, April 29 - May 27, 2009 (7 – 9 PM)


May 16 & 17, 2009 (must attend both days)
September 12 & 13, 2009 (must attend both days)

9:00 a.m. to 5:00 p.m. each day Tolstoy Foundation, 104 Lake Road, Valley Cottage, NY 10989

Registration Form Please note: This workshop is for people, not pets. Please DO NOT bring your pet to the workshop. Full Name: Complete Address: Day Phone: (

)

Night Phone: (

Cell Phone: (

)

E-Mail:

Pet type (cat, dog, etc.): Age of Pet:

)

Breed if known: Volunteers without pets are welcome. Check here if you would like to volunteer with our program (or any visiting pet program) but do not have a pet


How did you hear about our workshop?

Are you interested in making visits with our program in the Rockland County area?

Do you plan to make visits with your Delta Society Pet Partners credentials in your own area?

Yes
No
Yes
No
Have you done any obedience training with your pet? Yes
No
If you answered yes, please tell us about your training.

List any titles that your pet has earned (CGC, etc.).

Have you taken the Delta handler class before? Yes
If yes, when and where?

What population(s) are you interested in working with?

What is your occupation?

No


Check all that apply: Are you interested in: day visits
night visits
weekend visits
?

Tell us a little about yourself and your pet. Continue on other side, as necessary.

Do you need overnight accommodations? Dorm rooms and B&B rooms are available at the workshop location for a nominal fee. For information, call 845-267-8795 or email [email protected] See next page for registration fees.

Workshop Fees: ote that workshop fees include the Delta Society Pet Partners training manual, other class materials, and lunch both days. Total fee for the 2-day workshop: $125 __ Senior citizen (age 60+): $100 __

For other fees, see below *OTE: Taking this workshop qualifies you for a discount on our next R.E.A.D. workshop. Please let us know if you are interested in taking that program as well.

Questions? If you need help with the registration fees, call us at 845-267-8795 or email us at [email protected] Two members of the same family taking the workshop: If two adult members of the same family plan to make pet visits together, with both of them registered as handlers, they can take the workshop together and share a manual. In that case, please send two registration forms and a combined registration fee of $220. (If one or both are seniors, the combined registration fee is $170.) Children age 10 to 15 can take the training and participate in the Delta Society Pet Partners program with their pets if they are accompanied by a parent or responsible adult. The same parent or adult must accompany the child to the training class, evaluations, and all visits. To register a child/children for the Delta workshop, list the child's name and age: Name:_____________________________________________ Age: _________ Name:_____________________________________________ Age: _________

FAMILY PLAN: There is no fee for the accompanying adult for the workshop or for an additional child. All family members who attend the workshop will receive a certificate of attendance and may register for the Delta Society Pet Partners evaluation with the family’s pet or pets. However, each lunch served at the Tolstoy Foundation main house costs $13.50. Please add $13.50 per extra meal (Saturday and Sunday) per child.

Total tuition fee for child/children with accompanying adult: $125.00 ____ Lunch fee ($13.50 per extra person per meal, or $27 total per person) ____ Total amount enclosed: ____

Please make your check payable to HVHS Visiting Pets and mail your check and all three pages of this completed form to (you can pay via PayPal on our website if you prefer, but please send the forms to us): Delta Workshop, HVHS Visiting Pets Attn: Dolores Tolstoy Foundation 104 Lake Road Valley Cottage, Y 10989 We will send a confirmation e-mail or contact you by phone after receiving your registration form. Taking this workshop qualifies you for a discount on our next R.E.A.D. workshop; let us know if you are interested. If you have questions, please call 845-267-8795 or send us an e-mail at [email protected]. Please also visit our website for updates at www.HudsonValleyVisitingPets.com.

TOLSTOY FOUNDATION CENTER, 104 LAKE ROAD VALLEY COTTAGE, NY 10989 Driving Directions Note: When you enter the Tolstoy Foundation grounds, drive straight back, all the way back to the onestory white dormitory building. DO NOT park in the church parking lot next to the road or in any of the residents’ parking places. Thank you! From New York City: Take the George Washington Bridge to Palisades Interstate Parkway North. Take Exit 5N (303-North). Proceed on 303-North for approximately 6 miles (past Palisades Mall on the left, followed by a Saturn dealership on the right). About a mile north of the Thruway and just past the Valley Cottage Library, turn right at the traffic light onto Lake Road. This is the first traffic light you will come to, and the intersection is NOT well marked! Landmarks are a drug store strip mall diagonally across the street on left, Shell gas station directly across the street on left, Chase Bank across the street on right, and a convenience mart directly to your right. As soon as you turn right, Christian Herald Road will be on your right and Ridge Road on your left, making this (almost) a 5-way intersection. Proceed on Lake Road for approximately 1 mile. Go past the Tolstoy Foundation Nursing Home on your left. Next driveway on left is the Tolstoy Foundation Center. Tolstoy’s St. Sergius Russian Orthodox Church with its onion dome will be visible from the street. Drive straight back, all the way to the white one-story building, which is the dormitory building. From the Tappan Zee Bridge: Take the NY State Thruway north to Exit 12 (303/West Nyack). Stay to the right as you exit, following signs to Route 303. At the traffic light, turn left onto Route 303-N. The next traffic light will be at the Saturn dealership. Follow directions above. From Upstate New York: Take the NY State Thruway to Exit 12 (303/West Nyack). Or take Route 17 South or the Palisades Parkway South to the Thruway and continue toward NY City until you reach Exit 12 (303/West Nyack). At the traffic light at end of the off-ramp, turn left. The Palisades Mall will be directly in front of you. Follow signs to Route 303, and turn left at the next traffic light onto 303-North. Follow directions above. Alternatively, take Route 17 or the NY State Thruway to Harriman, NY (Route 17 Exit 131, Thruway Exit 16) and take Route 6 (Bear Mountain Bridge) east to the Palisades Parkway. Take Parkway south to Route 9W. Take Route 9W south to Lake Road in Valley Cottage at the south entrance to Rockland Lake Park. (Do not confuse this with the north entrance to Rockland Lake Park on Lake Road in Congers, NY. In other words, drive past the first Lake Road at Rockland Lake Park.) Turn right. Tolstoy Foundation will be approximately ½ mile on your right. (Taking Route 6 from Harriman to the Palisades Parkway to Route 9W will shorten your trip considerably.) From New Jersey: Take the Garden State Parkway North to the New York State Thruway (toward New York City/Tappan Zee Bridge). Take Exit 12 (West Nyack/303). Follow signs to 303-North. Follow directions above. From Connecticut: Take 95-South to 287-North to the Tappan Zee Bridge. Go over the Tappan Zee Bridge. Take Exit 12 (303/West Nyack). Stay to the right as you exit, following signs to Route 303. At the traffic light at Route 303, turn left onto 303-North. The next traffic light will be next to the Saturn dealership. Follow directions above. Within Rockland County from 9W-South or North: After entering Valley Cottage, turn onto Lake Road (across the street from the south entrance of Rockland Lake). Drive past Liberty Elementary School and continue to 104 Lake Road. The Tolstoy Foundation will be on your right. Need other directions? Call us at 845-267-8795 or send an email to [email protected]. Hudson Valley Humane Society Visiting Pet Program 104 Lake Road, Tolstoy Foundation, Valley Cottage NY 10989 845-267-8795, [email protected], www.HudsonValleyVisitingPets.com