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I am
enrolling my teen in: Date of
Class:________________________________
Please Check desired
class: Session 1 ___ Session 2 ___ Session 3 ___ All 3 Sessions
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Name
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Age
Grade
Birthday
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Address
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City, State & Zip
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Parent's Names
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Home Phone #
Work #
Cell #
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E-Mail Address for Class Confirmation
Where did you hear about us?
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Hobbies and Awards
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What would you like your child to gain?
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List any food allergies, medical conditions, or current
medicines your child is taking:
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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
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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
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