Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  237 - Creating Movement Phrases
Date:
  Sunday, June 02, 2019 - One Day Class
Time:
  9:30 am - 11:00 am
Class Fee:
  $ 35.00 (Choose one)
Notes:
  Checks, Major Credit Cards or Paypal Accepted. Email Judy@DogsCanDance.com to request a Paypal invoice. Make checks payable to: Dogs Can Dance. Deadline to Register is May 20.
Location:
 

Camp Run A Mutt L.A.X.
11121 Hindry Ave.
Los Angeles, CA 90045

     
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 Camp Run A Mutt L.A.X. 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, 28 March 2024 04:08 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