Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
   271 - Flow Workshop - intermediate/advanced
Date:
   Tuesday, October 18, 2022 to Tuesday, November 08, 2022
Time:
   12:00 noon - 12:00 noon
Class Fee:
   $ 55.00       Audit Only Fee: $ 45.00 (Choose one)
Notes:
   Lessons are delivered on video to your email in box. This class can be done in a small space.
Location:
  

Internet
your home
Available Online, CA 95687

     
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, 18 April 2024 04:28 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