Therapy Dog Class Payment Form
Start September 8, 2024
LEGAL Name of Owner
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Name of Emergency Contact
*
First Name
Last Name
Emergency Contact Cell Phone
*
Please enter a valid phone number.
Name of Dog
*
Dog's Date of Birth
*
-
Month
-
Day
Year
Date
Dog's weight
*
Dog's Breed
*
Has this dog earned a AKC CGC Title?
*
YES
NO
Please List Classes you have taken with this dog:
*
Please Upload Dog's Rabies Certificate (with Expiration Date)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Therapy Dog Classes:
prev
next
( X )
Non-Member/Other Members
6 weeks/ 90 mins sessions
$
225.00
Member in Good Standing
6 weeks /90 mins sessions
$
150.00
Member with TC Discount ONLY
6 weeks/ 90 mins sessions
$
130.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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