Enrollment Form for "Mannerly Kids"

Children Ages 5 -10
Enrollment Form
Please print the form and register by mailing or faxing the completed form to the address below.
This form is for our one day class only. If you are registering for our Summer Camp, please go to the home page and click on our Summer Etiquette Camp Registration Form.

I am enrolling my child in: Date of Class __________________________

Name Male or Female

Age Grade Birthday

Address

City, State & Zip

Parent's Names

Home Phone # Work # Cell #

E-Mail Address for Class Confirmation Where did you hear about us?

Hobbies and Awards

What would you like your child to gain?

List any food allergies, medical conditions, or current medicines your child is taking:

Please Mail Form with Class Fee to Hold Space in Class.
Full Payment Required. Credit Card Enrollment can be Faxed.
Please Make Checks Payable to Academy of Etiquette

Amount Enclosed____________________ Circle Credit Card - MC Visa Discover AMEX
Credit Card #__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __Expiration Date_____________
Name as it appears on the card:___________________________ Charge Amount ___________
Signature____________________________________________ Date ___________________
**Photocopy completed form for your records. Space is limited, so return this form with required registration fee. Complete a separate form for each child; please photocopy this registration from as needed. Registration is due 3 weeks before each class begins. Late registrations will be accepted, space permitting. If cancellations are made prior to 3 weeks before start of specific class, parent will only receive a 50% refund of class fee. If parent cancels class after 3 weeks prior to start of specific class, the fee is non-refundable. Call Julie Dern at 407-884-4130 for additional information regarding Classes or Camps .

Post Office Box 608604 Orlando, Florida 32860 Fax 407-884-5490 www.academyofetiquette.com