Children Program Registration

Mail Payment To:
The Etiquette Factory by Miss Kim LLC
Class Name: Perfectly Polite Dining and Etiquette Class -Crocker Park-Burntwood
Number of Classes: 1
Instructor: Kimberlee
Class Beginning Date: Apr 6, 2019
Class End Date: Apr 6, 2019
CLass Time: 11:00-1:00
Recommended Age: 8-15
Location of Class: Burntwood Tavern, Crocker Park
12 Main Street
Westlake, Ohio 44145

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