Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  211 - Concepts of Creating
Date:
  Tuesday, November 07, 2017 to Tuesday, December 12, 2017
Time:
  12:00 noon - 12:00 noon
Class Fee:
  $ 50.00 (Choose one)
Notes:
  No video homework or discussion included with this class. If you need a Paypal invoice, please email Judy@DogsCanDance.com
Location:
 

Internet
your home address
Available Online, CA 95696

     
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 Wednesday, 22 November 2017 04:30 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