Young People Enrollment Application

Classes(*)

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Child's First Name(*)

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Child's Last Name(*)

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Parents Name(*)

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Street Address(*)

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City(*)

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State(*)

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Zip

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Parents Email Address(*)

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Phone (Day)

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Phone (Evening)

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Phone (Cellular)

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Child Age

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Grade

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School

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Do you have any food allergies or dietary requirements?(*)

YesNo

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Allergy Details - Please list(*)

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Please explain how registration fees will be paid(*)

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Payment Method

Check (Payment address: P.O. Box 4361, Antioch, CA 94531)

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Cash

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No refunds or carryovers 14 days prior to the start of the class

I Agree

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Client Photo Release

I hereby consent to and authorize the use and reproduction by The School of Etiquette and Decorum of any and all photographs which have been taken of me during the Etiquette training classes. Pictures may be used on brochures, newspaper or web-site. (Please check our picture gallery @ www.etiquetteschool.us to preview how pictures have been used in the past).

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For additional information, Contact Office @ 925-519-0354 or Email: Etiquette4decorum@yahoo.com

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Young People Enrollment Application

Client Photo Release