Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  266 - Dogs Can Dance with Monica
Date:
  Monday, September 09, 2019 to Monday, October 21, 2019
Time:
  5:00 pm - 6:00 pm
Class Fee:
  $ 79.00 (Choose one)
Notes:
  Have fun with your dog by incorporating obedience and tricks to music. Learn basic dance moves and what music your dog likes best. Some prior obedience or agility training recommended. Contact Monica: nolanmilano@gmail.com
Location:
 

Thousand Oaks Community Center
2525 N. Moorpark Road
Thousand Oaks, CA 91360

     
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 Thousand Oaks Community Center 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 -

Conejo Recreation & Park District
Thousand Oaks Community Center
2525 N. Moorpark Rd.
Thousand Oaks, CA 91360