Rally Class Payment Form
This form is ONLY for students currently enrolled in classes with Samantha at SICDTC or pre-approved by registrar/instructor. Click on PayPal to access the Venmo or Pay Later Link
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Dog's Name (if Multiple Dog's Add in Comments below)
*
Start Date of Session
*
-
Month
-
Day
Year
Date
Comments or Multiple Dog Information
Choose ONE option below: If you have club vouchers please contact Desma (sicdtc@hotmail.com) to get a coupon code
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Rally Class Fee -SICDTC -NON-Member
8 week classes with instructor Samantha Scicchigno
$
215.00
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4
Item subtotal:
$
0.00
Rally Class Fee -SICDTC Member in Good Standing
8 week class with Instructor Samantha Scicchigno
$
145.00
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4
Item subtotal:
$
0.00
Rally Class Fee- Member w/TC Discount ONLY
8 week class with Instructor Samantha Scicchigno
$
125.00
Quantity
1
2
3
4
Item subtotal:
$
0.00
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
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the form.
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