RALLY Class Registration Form

RALLY CLASS with Samantha Scicchigno Registration Form

Fill out the form carefully for registration. IMPORTANT!! YOUR REGISTRATION IS NOT APRROVED UNTIL YOU RECEIVE A CONFIRMATION EMAIL FOR SAMANTHA If you have any questions contact Samantha -samscicchigno@gmail.com
IMPORTANT! ALL NEW STUDENTS ARE REQUIRED TO SIGN A GENERAL LIABILITY WAIVER. This waiver only needs to be signed once. Once you have a waiver on file it is valid for any class or event at SICDTC.

After you submit this form a link will appear which will take you to the form
LEGAL Name *

First NameLast Name
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail *
example@example.com
Mobile Number *
Format: (000) 000-0000.
Emergency Contact *

First NameLast Name
Emergency Contact Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Dog's Name/Breed/Gender*

NameBreed/Gender
Dog's Date of Birth*

MonthDayYear
Date
At what level of Rally are you training? Anything else I should know about your dog? If you have multiple dogs you can add their information below
Should be Empty:

RALLY CLASS with Samantha Scicchigno Registration Form