Beginner Agility Class Registration Form

Class size is limited and class openings are filled as payment and registration is received.  To register, print and fill out the completed form and send it in along with the $60.00 non-refundable class fee.

For more information, contact Betty at (765) 962 – 4389 or (765) 886 – 5191.

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(Your name)

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(Address)                                                                                           (City/Zip)

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(Telephone number)

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(Dog’s Name)                                                                                    (Date of Birth)

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(Breed)

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(Owner’s Signature)                                                              (Amount Enclosed)

Make checks payable to:

Greens Fork Animal Hospital

8089 State Road 38

Greens Fork, Indiana 47345