360 Academy Registration Form

360 Academy Registration Form

@ Woolston Community Centre
Customer Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
E-mail*
example@example.com
Please provide an Emergency Contact*

First NameLast Name
Phone Number*
Dog's Name*
Dog's Date of Birth:*
Dog's Breed:
Does your dog have any health issues, allergies or behaviour concerns?*

YesNo
If yes, please provide more information below:
How would you prefer to receive any of the information and/or training methods discussed during our session(s)

Bullet PointsShort step by step instructionsVideoInfographicsAny/No preference
We might require to contact you from time to time, for example if we need to change course or class dates/times, confirm your attendance or in the event of the training classes being cancelled due to unforeseen circumstances. No SPAM nor promotional email/messages will be sent. Please advise your preferred contact method from the options below:*

EmailPhoneFacebook PM
Are you happy for us to take pictures of you and your pet during the course and post them on our Social Media accounts?*

YesNo
How did you hear about us?*
Would you like to receive news about future Courses, Workshops or Offers?

YesNo
Please confirm you have read our T&C at https://www.360pawsibilities.co.uk/terms-and-conditions/ and accept them:*

I can confirm I have read the T&C and I accept them
DISCOUNT CODE?
*
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360 Academy
£114.00

Total

£0.00
Should be Empty: