Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
  274 - From Dream to Dance Intensive = 21CEUs
Date:
  Thursday, August 03, 2023 to Thursday, November 30, 2023
Time:
  12:00 noon - 12:00 noon
Class Fee:
  $ 275.00       Audit Only Fee: $ 175.00 (Choose one)
Notes:
 
Location:
 

Internet
Your Home
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 Monday, 27 November 2023 10:05 pm


Fill in, print, and mail the form along with all applicable fees to -

Dogs Can Dance
Dogs Can Dance
PO Box 1093
Vacaville, CA 95696