Children Program Registration

Mail Payment To:
The Etiquette Factory by Miss Kim LLC
Class Name: Nordstrom- Holiday Children's Dining Etiquette
Number of Classes: 1
Instructor: Kimberlee
Class Beginning Date: Dec 15, 2018
Class End Date: Dec 15, 2018
CLass Time: 9:30-11:30
Recommended Age: 6 +
Location of Class: Nordstrom- The Grill
26200 Cedar Road
Beachwood, Ohio 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