I am enrolling my child in:  Date of Class_________________________________
  

    Name                                                          Parent's Names  

 
   Age                                                         Grade                                                   Birthday 

 
   Address

 
   City, State & Zip  

 
   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 or $25 Deposit to Hold Space in Class.
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 ___________________
*Class cancellation must be made 72 hours prior to class time.  The Deposit is non-refundable.
         
Post Office Box 608604 Orlando, Florida 32860  Fax 407-884-5490  www.academyofetiquette.com