Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  184 - Entry Level Success
Date:
  Tuesday, October 15, 2019 to Tuesday, November 19, 2019
Time:
  12:00 noon - 12:00 noon
Class Fee:
  $ 100.00       Audit Only Fee: $ 60.00 (Choose one)
Notes:
  Access to a video camera and space to film is required. Videos will need to be linked up to either YouTube, Vimeo, or You Send It.
Location:
 

Internet
Your home street
Available Online,

     
Please Enter the following information
First Name:
 
Last Name:
 
Street: :
 
Unit/Apt Num::
 
City:
 
State:
 
Tel:
 
Email:
 
     
Dog's Name:
 
Dog Breed:
 
Payment Information:   Visa M/C
 
Name:
 
Card Number:
 
Expiration Date:
  Month Year    
Security Code:
  (3 digits - back of card)
Amount Total :   $_________________
Note: Telephone number or e-mail address required for ALL credit card orders. For your security we do not keep any credit card information on file. Once the order is processed, we destroy all credit card information.
     

Liability Waiver: I agree to hold harmless Dogs Can Dance LLC, Judy Gamet, and the owners of Internet in the event of an injury prior to, during, or after the workshop or classes. I understand that my only reimbursement in the event of an injury is my own insurance.

*Signature ___________________________________ Date_______________

This Form created on Thursday, 12 December 2019 04:27 am


Fill in, print, and mail the form along with all applicable fees to -

Dogs Can Dance
Dogs Can Dance
PO Box 2117
Vacaville, CA 95696