Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  236 - Beginner Class - non member rate
Date:
  Sunday, October 22, 2017 - One Day Class
Time:
  3:00 pm - 4:00 pm
Class Fee:
  $ 25.00       Audit Only Fee: $ 20.00 (Choose one)
Notes:
  Checks, Major Credit Cards or Paypal Accepted. Email Info@DogsCanDance.com to request a Paypal invoice. Make checks payable to: Dogs Can Dance. No charge for this class if paying for the full day of training. Deadline to register: Oct 15.
Location:
 

Yellow Brick Road Doggie Playcare & Gym
1501 E. El Segundo Blvd.
El Segundo, CA 90245

     
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 Yellow Brick Road Doggie Playcare & Gym 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 Tuesday, 19 September 2017 07:50 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