Speciality Class Registration Request – Dog Training Club of Champaign-Urbana

First Name *

Last Name *

Street Address *

City *

State *

ZIP / Postal Code *

Phone *

Email Address *

Participant Waiver *

I have read and agree to the Participant Waiver

Have you been voted in as a Dog Training Club of Champaign Urbana club member? *YesNo

Using Teacher Priority? (must have taught Winter 2023) *YesNo

Your dog's name *

Your dogs breed *

Is your dog current with their required vaccinations? *YesNo

Is your dog male or female *MaleFemale

Has your dog passed their Canine Good Citizen (CGC) test? *YesNo

What class are your registering for today? *

If your class request is accepted, how do you intend to pay? *by credit card (Visa, Discover, or Mastercard)in person (on first day of class by check or cash)by class card (held by instructors)