Children Program Registration

Mail Payment To:
The Etiquette Factory by Miss Kim
Class Name: Perfectly Polite Dining Etiquette -Lawerence School Parents
Number of Classes: 1
Instructor: Kimberlee
Class Beginning Date: Aug 8, 2021
Class End Date: Aug 8, 2021
CLass Time: 10:00-11:30
Recommended Age: 10 - 15
Location of Class: Pinstripes - Pinecrest
111 Park Ave Suite 105
Beachwood, OH 44122

Student Information

Child's Name
Gender
Male
Female
Age
Emergency Contact Phone
Any food allergies or religious or cultural food, personality/ developmental concerns? My indicating your concerns we can the accommodate you needs.

Parent Information/Guardian

Name
Email
Daytime Phone
Evening Phone
Payment Information (select one)
I will be mailing a check along with the registration form
I would like an invoice emailed to me